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  • Updated 08.22.2018
  • Released 09.16.2013
  • Expires For CME 08.22.2021

Cognition and epilepsy

Introduction

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 (49; 72), evidence suggests nonverbal memory is represented more bilaterally (68).

• 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 (13; 43; 47; 52).

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

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