Abstract
Disturbances in cognitive function, particularly memory, are a common complaint of patients with epilepsy. Factors contributing to cognitive dysfunction are the type of epilepsy, type and frequency of seizures, anti-epileptic drugs and the location of underlying brain lesions. Whilst a great deal of attention has been paid to permanent cognitive impairment, the nature and underlying mechanisms of ictal and peri-ictal cognitive changes are poorly understood. In-depth investigation of seizure related cognitive dysfunction is of great clinical relevance, as these changes are potentially reversible and treatable, thus reducing the cumulative effect of frequent seizures Greater knowledge of peri-ictal and ictal cognitive dysfunction would improve seizure prediction, localization of seizure focus and assessment of treatment effectiveness, greatly reducing distress and disability. This paper will review current understanding of peri-ictal and ictal cognitive dysfunction and discuss future directions for research.
Highlights
Disturbances in cognitive function, memory, are common complaints of patients with epilepsy and result in considerable distress and disability [2,13]
Despite the weaknesses of this study, such as its retrospective nature and lack of EEG confirmation of the pre-ictal state, the findings indicate that further research in this hitherto neglected area is necessary
These profiles may be modified by the type of seizure, type of epilepsy, location of seizure focus and/or underlying lesion and concurrent treatment with antiepileptic drugs
Summary
Disturbances in cognitive function, memory, are common complaints of patients with epilepsy and result in considerable distress and disability [2,13]. Cognitive dysfunction in epilepsy may be either permanent and irreversible, resulting from congenital brain damage or temporary and potentially treatable, resulting from on-going seizure activity (statedependent cognitive dysfunction). In 1994, it was noted that the concept of state-dependent, or seizure-related cognitive dysfunction was less widely acknowledged compared to permanent cognitive impairment related to congenital brain damage in epilepsy [8]. Seizures may cause disruption of cognitive functions, yet some cognitive processes may themselves precipitate seizures, i.e., reflex epilepsies. Cognitive precipitants of seizures have been discussed in detail in recent reviews [9,26] and will not be addressed here. A clear definition of the various terms and concepts addressed in this review will be followed by a discussion of current understanding of peri-ictal and ictal cognitive dysfunction
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