Epilepsy and Cognitive Impairment

Abstract

Cognitive impairment is prevalent in epilepsy. Studies have revealed that up to 70%–80% of epilepsy patients have various degrees of cognitive impairment in attention, executive function, language function, and memory. Factors associated with cognitive impairment include, but are not limited to, genetic predisposition; medications (including antiepileptic drugs); structural lesions; degenerative processes; mood disorders; type, frequency and severity of seizures; age of onset; and duration of epilepsy. Antiepileptic drugs, including barbiturates and topiramate, are known to affect cognitive function. However, cognitive impairment is frequently noticed at the onset of epilepsy and antiepileptic drugs usually are not independently associated with cognitive dysfunction. In addition, caution is needed that other factors associated with cognitive impairment does not necessarily entail a causal association. The existence of a common pathomechanism underlying both cognitive impairment and epilepsy should be considered. Vascular insult and tau pathology may underlie both cognitive impairment and epilepsy. Surgery could be a good treatment option for refractory epilepsy. Potential cognitive adverse events following the surgical removal of brain tissue are limited and could be outweighed by succesful seizure control and improved quality of life. Key words: Epilepsy; Cognitive impairment; Elderly; Antiepileptic drug; Epilepsy surgery.