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  • Updated 12.20.2023
  • Released 09.16.2013
  • Expires For CME 12.20.2026

Cognition and epilepsy



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 can accompany epilepsy in predictable ways, and its direct quantification through cognitive assessment can assist in lateralizing and localizing a surgical focus. However, substantial heterogeneity is often observed in cognitive and neurobehavioral presentations across patients, thus requiring a phenotypic/precision medicine approach to better characterize cognition in epilepsy (44).

• Memory impairment can implicate mesial temporal seizure onset. The historic “material specific” model of memory impairment predicted that damage in the dominant and, to a lesser extent, nondominant mesial temporal lobe affect verbal and nonverbal memory (respectively) in a predictable manner (64). The view has been challenged by evidence showing that nonverbal memory is more bilaterally represented (72).

• In temporal lobe epilepsy, validated equations exist to quantify surgical candidates’ risk of a postsurgical decline in naming (24), verbal memory (25), and mood symptoms (32).

• Resection of posterior inferior temporal cortex (eg, basal temporal language area including the fusiform gyrus) and surrounding white matter predicts naming (decline after surgery) (18; 01; 50).

• 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 (58; 66; 74; 40), though evidence for clinical use of fMRI for memory mapping remains limited (96).

• Psychiatric and psychosocial assessment is critical in presurgical evaluation and clinical management to optimize patient outcome (67).

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ISSN: 2831-9125