Neuropsychology in non-lesional epilepsy

This review of the literature describes cognitive functions in patients with non-lesional focal epilepsy as compared to healthy controls as well as patients with epileptogenic lesions. Furthermore, risk factors for cognitive impairment, especially after temporal lobe surgery, are discussed.MRI-negative patients sometimes show impaired cognitive functions already shortly after epilepsy diagnosis, but especially during the course of the disease they reveal diminished performance in all cognitive domains (attention, memory, language, visuospatial, and executive functions). Compared to patients with focal epilepsy due to a visible lesion, they demonstrate less or even comparable impairments. For both groups younger age at epilepsy onset correlates with cognitive deterioration and less seizure control. Surgery within the language dominant temporal lobe as well as good preoperative performance are risk factors for cognitive decline after epilepsy surgery.Altogether, MRI-negative patients show cognitive performances between healthy controls and patients with lesional epilepsy. The prognostic factors for postoperative cognitive worsening apply to all patients with focal epilepsy, independent of an epileptogenic lesion.