Cognitive dysfunction in patients with epilepsy: focus on clinical variables

  A variety of factors can affect cognitive functions in patients with epilepsy, with the majority of cognitive problems having a multifactorial origin. In routine clinical practice, it can be difficult to dissect out the contribution of all of the different variables, because they are often interlinked together. In this article, all of the major variables implicated in cognitive dysfunction in epilepsy are discussed. In general terms, it is widely accepted that cognitive dysfunction in epilepsy can be trait dependent or state dependent. The former is a permanent condition due to the underlying brain damage or disorder, while the latter is a potentially reversible condition due to modifiable factors, such as antiepileptic drugs, seizure frequency and pattern and psychiatric comorbidity. Neuropsychological deficits also represent an important sequela in epilepsy surgery. Visual naming and visual memory loss have been clearly associated with temporal lobe surgery. It seems that the laterality of resection is not a major determinant, while the extension of resection is relevant for visual naming.