Chapter 28 - Clinical neuropsychology in epilepsy: theoretical and practical issues

Abstract

Abstract For an understanding of cognitive impairment in epilepsy, it is essential to appreciate that static and dynamic factors affect brain function in this disease. Whereas morphological lesions or structural changes are associated with more or less irreversible deficits, epileptic activity, seizures, and the treatment of epilepsy can cause dynamic and largely reversible impairments. The contribution of these factors varies depending on the type of epilepsy, the age at lesion/epilepsy onset, the localization and lateralization of the epilepsy, and individual demographic patient characteristics. Altered brain structure and function can result in epilepsy, but epilepsy can also alter the functional cerebral organization of the brain. Thus, epilepsy-related cognitive impairment must be seen within a developmental neuropsychological framework. From a neuropsychological point of view, it is essential as to whether epilepsy affects the maturing versus the mature or aging brain. Epilepsy can result in retardation, loss of acquired functions, or accelerated mental decline. Cognitive impairments in epilepsy often exist from the commencement of the epilepsy; early-onset lesions/epilepsy interfere with mental development; and a progressive etiology, severe seizures, and lesions secondary to epilepsy can accelerate mental decline. Uncontrolled epilepsy and epileptic activity, as well as the treatment of epilepsy, may reversibly and irreversibly affect cognition. Within this framework, neuropsychology has become an essential diagnostic tool for the early detection and monitoring of cognitive impairment and its determinants in newly established and chronic epilepsies. Neuropsychology serves as a valuable tool for quality and outcome control of the treatment of epilepsy and helps to improve the individual medical care of patients with epilepsy.