Network reconfiguration and working memory impairment in mesial temporal lobe epilepsy

► Effects of hippocampal sclerosis (HS) on effective connectivity were evaluated. ► HS induced a network adjustment in the ipsilesional and the contralesional hemisphere. ► Strength in ipsilesional and contralesional couplings was negatively related. ► Contralesional couplings were inversely related to performance and level of education. ► These findings support the notion that network alterations underlie cognitive decline.