Several blogs at LanceFogan.com (Blog #145: Epilepsy Patient Passes Driving Test After Brain Surgery; and Blog #121: If Your Seizures Aren't Controlled Epilepsy Surgery Is Safe and Really Can Help) have highlighted the effectiveness of epileptic surgery. The foci of abnormal brain cell neurons in focal epilepsy poorly responsive to anti-epilepsy drugs (AEDs) are removed. If surgically removing these cells is considered safe and the surgery would not affect speech, movement, sensory, memory and visual abilities, this treatment should be strongly considered. Surgical intervention commonly is the best effective, and commonly curative treatment.
Long-term studies have shown that
after successful epilepsy surgery in the great majority of patients their brain
performance recovers. However, recent studies at the University of Bonn,
Germany1 found after the
successful surgery that in rare cases neuropsychological performance declines
months later. The study found that the surgical tissue removed indicates a rare
secondary independent, neurodegenerative disease beyond any direct surgical effects. Evidently, a small subset of patients experiences
a significant cognitive decline following surgery for temporal lobe epilepsy
(TLE), independent of and in addition to the eventual cognitive sequelae of the
surgical treatment. Who are these patients, and what are the underlying causes?
Eight percent of all 355 patients
in the study with at least 2 neuropsychological assessments after epilepsy
surgery showed a relevant cognitive decline from one postoperative follow-up examination
to a subsequent evaluation. The most frequently affected cognitive domain by
far was verbal memory (96%), followed by figural memory (33%) and executive
functions (25%). Repeated cognitive declines in the time after surgery were
observed in 5 of the 24 patients (21%).
The findings indicate that patients who unexpectedly
displayed unfavorable cognitive development beyond any direct surgical effects
show rare and very particular pathogenetic causes or parallel, presumably
independent, neurodegenerative alterations. In those affected, was the removed
tissue damaged by secondary disease at the time of surgery - either through
inflammation or incipient Alzheimer's dementia-like? The researchers considered
with these pre-existing conditions; the body's defenses are particularly active.
It's possible that the trauma of the surgical procedure further stimulates the
immune system in the brain to attack healthy brain tissue." Further
studies are indicated.
- Reimers A, Helmstaedter C, Elger C, et al., "Neuropathological Insights into Unexpected Cognitive Decline in Epilepsy." Ann Neurol., Nov 2022
Lance Fogan, M.D. is Clinical Professor of
Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting
emotional family medical
drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first
novel. Aside from acclamation on internet bookstore sites, U.S. Report
of Books, and the Hollywood Book Review, DINGS has been advertised in recent
New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers
Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft
and hard cover editions.
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