[Neuropsychology and cognitive deterioration in epilepsy]

To carry out a critical evaluation of the international literature on the neuropsychology of epilepsy. The variables which lead to cognitive deterioration in epilepsy and the effect on cognition of different treatments available (pharmacological and surgical).

We evaluate the influence of different neurological variables on the higher functions (aetiology, age of onset, type of crises, duration of illness, frequency and anti-epileptic drugs). We also describe the cognitive functions most affected in epilepsy (memory, attention, executive function, language). Studies of the surgery of epilepsy show that this may lead to both beneficial and undesirable effects on cognition.

The variables which in general most affect higher functions are the duration of the illness and the frequency and types of crises. The commonest neuropsychological effects are those of memory deficit. These studies show that neuropsychological studies should be done from the time of onset of the disorder. Finally, from the surgical point of view, young patients with considerable crisis reduction or free of crises, with moderate preoperative deterioration of memory have the greatest possibility of post-operative improvement in cognition. Older persons with intact cognitive function and major surgical resection have more possibilities of post-surgical deterioration.