Neuropsychological Evaluation of the Epilepsy Surgical Candidate

Differential neuropsychological outcomes following targeted responsive neurostimulation for partial‐onset epilepsy

“…Cognitive side effects related to specific types of AEDs and epilepsy surgeries are well understood. [5][6][7][8][9][10] However, the cognitive effects of targeted responsive neurostimulation have not been previously investigated. This series provides evidence that adults with frequent, intractable, partial onset seizures treated with responsive neurostimulation are not at increased risk for developing cognitive dysfunction, and that some aspects of cognition may be improved.…”

“…Therapies for partial‐onset seizures must consider not only the impact on seizure frequency and severity, but also the impact on cognition. Cognitive side effects related to specific types of AEDs and epilepsy surgeries are well understood . However, the cognitive effects of targeted responsive neurostimulation have not been previously investigated.…”

“…Many antiepileptic drugs (AEDs) have adverse cognitive effects, [1][2][3] and although epilepsy surgeries offer the potential for great benefit in select patients with intractable partial-onset seizures, they carry risks for cognitive decline in areas specific to the region of brain resected or disconnected, depending on the pathologic-functional status of the tissue included in resection. [4][5][6][7][8][9][10] Responsive neurostimulation using the RNS â System (NeuroPace, Mountain View, CA, U.S.A.) is a U.S. Food and Drug Administration (FDA)-approved adjunctive treatment for medically intractable disabling partial-onset seizures in adults with one or two seizure foci. This treatment provides stimulation to the epileptogenic region in response to detection of physician-selected electrographic activity, which usually represents interictal epileptiform activity preceding the onset of electrographic seizures.…”

“…Persons with epilepsy are at risk for cognitive disability and decline, and the cognitive effects of treatment are an important component in evaluating overall effectiveness. Many antiepileptic drugs (AEDs) have adverse cognitive effects, and although epilepsy surgeries offer the potential for great benefit in select patients with intractable partial‐onset seizures, they carry risks for cognitive decline in areas specific to the region of brain resected or disconnected, depending on the pathologic‐functional status of the tissue included in resection …”

The Role of Stereotactic Laser Amygdalohippocampotomy in Mesial Temporal Lobe Epilepsy

“…These tests are used both to contribute to confirmation of the onset zone as reflected in relative areas of neurocognitive weakness (eg, material specific memory dysfunction) and also to prognosticate regarding potential loss of function after various surgical approaches, including SLAH. 13 Results with respect to cognitive domains at risk also contribute to procedural decision making, that is, destructive versus nondestructive (neuromodulatory) therapeutic procedures. Further, change from baseline after surgery is informative both academically and clinically and guides referral for cognitive rehabilitation when indicated.…”