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ABSTRACT
A variety of factors can affect cognitive functions in patients with epilepsy, with the majority of cognitive problems having a multifactorial origin. In routine clinical practice, it can be difficult to dissect out the contribution of all of the different variables, because they are often interlinked together. In this article, all of the major variables implicated in cognitive dysfunction in epilepsy are discussed. In general terms, it is widely accepted that cognitive dysfunction in epilepsy can be trait dependent or state dependent. The former is a permanent condition due to the underlying brain damage or disorder, while the latter is a potentially reversible condition due to modifiable factors, such as antiepileptic drugs, seizure frequency and pattern and psychiatric comorbidity. Neuropsychological deficits also represent an important sequela in epilepsy surgery. Visual naming and visual memory loss have been clearly associated with temporal lobe surgery. It seems that the laterality of resection is not a major determinant, while the extension of resection is relevant for visual naming.
Declaration of Interests
Financial & competing interests disclosure
Editor: Laura Dormer, Editor, Future Science Group.
Disclosure: Laura Dormer has disclosed no relevant financial relationships.
CME author: Laurie Barclay, MD, Freelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Author & credentials: M Mula, MD, PhD, Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St George’s Hospital, London, UK
Disclosure: Marco Mula, MD, PhD, has disclosed the following financial relationships: served as an advisor or consultant for: UCB-Pharma, Bial, and Pfizer
No writing assistance was utilized in the production of this manuscript.
Cognitive dysfunction in patients with epilepsy: focus on clinical variables
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Activity evaluation: where 1 is strongly disagree and 5 is strongly agree.
1. Your patient is a 23-year-old man with seizures secondary to a traumatic brain injury. He also has symptoms of cognitive impairment. According to the review by Mula, which of the following statements about trait-dependent cognitive dysfunction associated with epilepsy is correct?
A In structural focal epilepsies such as those from traumatic brain injury, stroke, or encephalitis, cognitive deficits are usually those expected from the lesion site
B Trait-dependent cognitive dysfunction in epilepsy is usually reversible
C Memory and psychomotor speed are usually unaffected in focal epilepsies of unknown cause
D Rett syndrome is associated with executive dysfunction
2. According to the review by Mula, which of the following statements about state-dependent cognitive dysfunction associated with epilepsy is correct?
A Potentially modifiable factors contributing to state-dependent cognitive dysfunction in epilepsy may include AEDs, seizure frequency and pattern, and psychiatric comorbidity
B Epileptic seizures themselves are not implicated in transient cognitive dysfunction
C A single generalized tonic-clonic seizure may produce reversible attention deficits for up to 3 days
D AEDs modulating voltage-gated channels have more detrimental effects on cognitive functions than those potentiating GABAergic neurotransmission
3. According to the review by Mula, which of the following statements about postsurgical cognitive dysfunction associated with epilepsy would most likely be correct?
A Temporal lobe surgery is not associated with visual memory loss
B Frontal lobe surgery is associated with visual naming deficits
C The laterality of temporal lobe resection is a major determinant of visual memory loss
D The extent of temporal lobe resection is relevant to postoperative visual naming deficits