Neuropsychological aspects of epilepsy surgery

Neuropsychological evaluation of a patient's cognitive capabilities before and after epilepsy surgery is essential in elective epilepsy surgery. On the one hand, neuropsychology provides accessory information regarding the localization and lateralization of epilepsy-associated cognitive impairment; on the other hand, it is a useful tool for quality and outcome control of epilepsy surgery which helps to make surgery more effective and safe. Evaluation of the adequacy of the brain tissues to be resected and of the patient's mental reserve capacities allows for a prediction of the postoperative cognitive development. Successful surgery can stop mental decline due to chronic epilepsy and it can reverse this negative trend by release of functions and capacities that were secondarily affected before surgery. However, surgery bears the risk of additional impairments which, in interaction with normal or even pathological processes of mental aging, may accelerate cognitive decline at an older age. From a neuropsychological point of view, early recognition of pharmacoresistance is important along with early and complete seizure control with maximal sparing of functional tissues.