Abstracts

Rationale: Up to 40% of patients undergoing dominant temporal lobe resection for epilepsy experience reliable declines in verbal memory and naming function. Cognitive rehabilitation (CR) is a well established therapeutic option for memory and other cognitive problems resulting from neurological disorders or insults. CR offers mnemonics and compensation strategy training aimed at improving daily functional performance in selected groups of patients. Although CR has been advocated in many reviews for epilepsy surgery, there is no notion regarding specific forms of CR applicable to this population, about its impact, or how often it is used. This systematic review of the literature aimed at (1) identifying the proportion of epilepsy patients in the literature who are offered CR as an element of post-surgical treatment, and (2) exploring the most commonly used CR approaches in epilepsy surgery patients. Methods: A comprehensive literature search using PubMed, EmBase, and the Cochrane databases identified articles published between 1991 and 2010, related to surgical outcomes of focal resective epilepsy surgery. All articles meeting inclusion and exclusion criteria were reviewed for further selection. All full-length articles published in English and containing pre-surgical and post-surgical neurocognitive performance were included. Additional references were identified from experts and from references of relevant articles. Results: Of 5254 citations related to epilepsy surgery, 148 included longitudinal cognitive outcome variables in patients with left and right operations. Twenty three studies (16%) described cognitive outcomes in detail, but none reported any form of CR, memory compensation strategies training, or any other form of CR. Nine additional references found from other sources described CR interventions as follows: internal compensatory strategies, external memory aids, psychoeducation, verbal and visual memory training, as well as exercises of attention and executive functions. The results of these interventions suggest that CR has a significant positive impact on verbal learning and memory performance. However, improvements seem also to be significantly related to the site of the surgery, attentional skills, mood, age, and education. Conclusions: Reliable cognitive declines in specific domains occur frequently after temporal lobe epilepsy surgery. Although memory rehabilitation is a well established therapy, it is not included as a standard element of post-surgical care, and the literature rarely mentions it. Sparse reports suggest that CR may benefit patients with left temporal lobe epilepsy who suffer from verbal memory decline, and that improvement is more likely in younger patients with less depressed mood, relatively strong concentration skills, and who are less educated. An expanded comprehensive search is underway focusing on these elements. CR should be given greater attention after epilepsy surgery to determine its efficacy and role in managing these patients.