Cognition and epilepsy

Susan Bookheimer PhD (Dr. Bookheimer of UCLA Semel Institute for Neuroscience and Human Behavior has no relevant financial relationships to disclose.)
Patricia Walshaw PhD (Dr. Walshaw of the UCLA David Geffen School of Medicine has reveiced payments from Bluebird Bio for performing neuropsychological assessments.)
Christopher Benjamin PhD (Dr. Benjamin of Yale University has no relevant financial relationships to disclose.)
Monika Polczynska PhD (

Dr. Polczynska of UCLA Semel Institute for Neuroscience and Human Behavior has no relevant financial relationships to disclose.

)
Jerome Engel Jr MD PhD, editor. (Dr. Engel of the David Geffen School of Medicine at the University of California, Los Angeles, has no relevant financial relationships to disclose.)
Originally released September 16, 2013; last updated August 22, 2018; August 22, 2021

Overview

This article reviews our current understanding of the cognitive changes that can accompany epilepsy and how these relate to cortical dysfunction. The authors explain the basics of the cognitive changes that accompany lesions frequently associated with epilepsy.

Key points

 

• Cognitive impairment accompanies epilepsy in predictable ways, and its direct quantification through cognitive assessment can assist in lateralizing and localizing a surgical focus.

 

• Assessment of different language functions indexes the functioning of cortical regions in the dominant hemisphere. Visuospatial deficits typically accompany nondominant hemisphere pathology.

 

• Damage in the dominant and, to a lesser extent, nondominant mesial temporal lobe affect verbal and nonverbal memory (respectively) in a predictable manner. Originally understood as the notion that the dominant mesial temporal lobe is closely associated with verbal memory and the nondominant, nonverbal memory (Milner 1971; Smith and Milner 1981), evidence suggests nonverbal memory is represented more bilaterally (Saling 2009).

 

• Improvement in technologies for presurgical mapping of cognitive functions is creating a shift away from invasive procedures to assess postsurgical risks for cognitive decline. Increasingly, functional MRI for assessment of language and memory is replacing the use of Wada testing and other invasive procedures, though this is still an area of hot debate (Bookheimer 2007; Loring et al 2014; Massot-Tarrús et al 2017; Papanicolaou et al 2018).

 

• Psychiatric and psychosocial assessment is critical in presurgical evaluation and clinical management to optimize patient outcome.

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