Effect of resective and destructive operations on cognitive functions in pharmacoresistant epilepsy

Abstract

Relevance . Epilepsy affects about 1 % of the world’s population, with 30–40 % of people having drug-resistant epilepsy (DRE). Despite its proven efficacy, surgical treatment of DRE remains associated with concerns about its negative impact on cognitive status. Objective . To compare the impact of resective and destructive surgeries on cognitive functions in drug-resistant epilepsy. Materials and Methods . The study was conducted at the Polenov Russian Scientific Research Institute. The object of the study was DRE, and the subject of the study was the dynamics of cognitive indicators during the postoperative period. The study included patients with DRE from the Registry of Patients Operated at Scientific Hospital No. 2 in 2 groups: group 1 – resective surgeries, group 2 – destructive surgeries. Clinical and demographic indicators, as well as the dynamics of cognitive functions according to MoCA before and after surgery, were studied with statistical analysis. Results . Fifty patients with EEF were included. The m:f ratio was 1.3:1, the mean age was 33.2±10.05 years, without statistically significant differences between the groups (p=0.26). The average duration of epilepsy before surgery was 20.7±10.98 years, without differences between the groups (p=0.31). Before surgery, most patients in the cohort (38 out of 50, 76 %) had a decline in cognitive func tions: the average score on the MoCA scale was 23.1. When assessing the dynamics of cognitive impairment in the postoperative period after 6–12 months, it was found that the number of patients with a decline in cognitive functions, as well as the average score on the MoCA scale, remained the same (38 patients out of 50, 76 %; 23.1 points). Conclusion . Surgical treatment and the type of surgical intervention did not have a negative impact on cognitive functions in the cohort of patients. The practice of late referral of patients with drug-resistant epilepsy for surgical treatment remains in place despite the preoperative level of cognitive impairment in 75 %.