[What is the role of neuropsychological testing in the investigation and management of pharmacologically intractable partial epilepsy?].
Neuropsychological testing is an integral part of investigation and management of pharmacologically intractable epilepsy. Patients often complain of cognitive difficulties, in particular memory disturbances. A review of the literature demonstrates that correlations between subjective memory difficulties and objective memory deficits are often poor with mood correlating more consistently with subjective complaints. Nevertheless, objective memory difficulties are often found, especially in patients with temporal lobe epilepsy. Many factors can contribute to cognitive difficulties in patients with pharmacoresistant partial epilepsy. These include brain pathology that may be the cause or the consequence of chronic seizures (or both), physiological brain dysfunction due to epileptic activity and effects of antiepileptic medications. We review some of the abundant relevant literature. Neuropsychological evaluation is routinely used in pre-surgical evaluations of patients and cognitive dysfunction has some degree of correlation with lateralization and localization of epileptic activity, thus helping to determine a surgical strategy. The goal of seizure control is tempered with an assessment of the potential cognitive loss resulting from resective surgery. A number of studies have addressed postoperative neuropsychological findings and it is universally recognized that patients who have high levels of cognitive functioning in the areas targeted for resection (for instance verbal memory in dominant temporal lobe) show the greatest functional loss following surgery. More selective surgery probably results in some level of preservation of cognitive function.
Unité Chirurgie de l'Epilepsie, Service de Neurologie et d'Explorations Fonctionnelles du Système Nerveux, Hopital Rangueil, 1 avenue du Professeur-J.-Poulhes, TSA 50032, 31059 Toulouse Cedex 9, France. valton.l@chu-toulouse.fr
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D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D001288:Attention / Q000187:drug effects; D019090:Case Management; D002540:Cerebral Cortex / Q000503:physiopathology; D002648:Child; D003072:Cognition Disorders / Q000139:chemically induced / Q000209:etiology; D003131:Combined Modality Therapy; D004292:Dominance, Cerebral; D004351:Drug Resistance; D004828:Epilepsies, Partial / Q000150:complications / Q000188:drug therapy / Q000523:psychology* / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy / Q000523:psychology / Q000601:surgery; D006801:Humans; D007361:Intelligence Tests; D007806:Language Disorders / Q000209:etiology; D007807:Language Tests; D008569:Memory Disorders / Q000139:chemically induced / Q000209:etiology; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D011597:Psychomotor Performance
D000927:Anticonvulsants