Epilepsy & Behavior 106 (2020) 107027

Contents lists available at ScienceDirect

Epilepsy & Behavior

journal homepage: www.elsevier.com/locate/yebeh

Targeted Review

Cognitive rehabilitation and prehabilitation in people with epilepsy

Sallie Baxendale ⁎
Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, UK
Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
University College Hospital, London, UK

a r t i c l e i n f o a b s t r a c t

Article history: Epilepsy is now recognized as a network disorder of the brain that can impact cognition beyond the periictal dis-
Received 2 March 2020 turbance associated with seizures. While there is a large literature on the assessment of cognitive functions, par-
Revised 4 March 2020 ticularly memory, in people with epilepsy, there are far fewer studies looking at the efficacy of treatments for
Accepted 4 March 2020
cognitive dysfunction in this population. Reviews of the cognitive rehabilitation literature in epilepsy have
Available online 21 March 2020
begun to outnumber original studies. This paper examines the possible reasons for this unsatisfactory ratio in
Keywords:
the literature and examines the unique challenges and opportunities for cognitive rehabilitation in this popula-
Epilepsy surgery tion, with a particular focus on epilepsy surgical candidates. The concept of prehabilitation in this population is
Cognition described. While traditional cognitive rehabilitation is implemented after a patient has developed a neuropsy-
Prediction chological deficit, in surgical candidates, prehabilitation uses intact functions before they are lost to establish
Memory compensatory strategies and routines prior to surgery in preparation for postoperative changes. The likely post-
Rehabilitation operative neuropsychological profile for individual patients can now be modeled using preoperative data. These
predictions can guide and inform the prehabilitation process. Rather than concluding with a generic call for more
research, the paper presents a framework for a rehabilitation program with practical solutions to address cogni-
tive difficulties in both surgical and nonsurgical populations of people with epilepsy.
© 2020 Elsevier Inc. All rights reserved.

Key questions
There are thousands of studies examining cognitive assessment in
epilepsy, but less than 50 published studies of interventions for
cognitive problems in this population. This review addresses the
following questions:
1. What are the conceptual and practical barriers to the study
of cognitive rehabilitation in epilepsy?
2. How should standardized cognitive rehabilitation programs
be modified to meet the unique challenges of cognitive re-
habilitation in people with epilepsy?
3. Is it possible to conduct preoperative/preemptive rehabilita-
tion (prehab) for anticipated surgically-induced cognitive
deficits in epilepsy surgery candidates?
4. Should rehabilitation programs in epilepsy include lifestyle
modifications?
⁎ ESRC Epilepsy Society, Chesham Lane, Chalfont St Peter, Buckinghamshire SL9 0RJ, UK.
E-mail address: s.baxendale@ucl.ac.uk.
1. Introduction
The epilepsy literature has benefitted from the publication of a num-
ber of thorough reviews of cognitive rehabilitation therapies in people
with epilepsy, with these reviews appearing at the rate of approxi-
mately once a year over the past few years [1–4]. All of these reviews
come to near identical conclusions; that this important area is signifi-
cantly under researched and that more research is needed. For example,
Mazur-Mosiewicz A et al. [2] concluded that “(cognitive rehabilitation)
interventions are overwhelmingly under-researched or underreported,
and there is a need for a systematic evaluation of (cognitive rehabilitation)
in this patient population. Cognitive rehabilitation should be given greater
attention after (epilepsy surgery) to determine its efficacy and role in the
management of these patients.” Two years later, Del Felice et al. [3] con-
cluded in their review that “Overall, there was insufficient evidence to
make definitive conclusions regarding the efficacy of traditional memory
rehabilitation strategies, brain training, and non-invasive brain stimula-
tion. The review suggests that cognitive rehabilitation in nonsurgical TLE
is under-researched and that there is a need for a systematic evaluation
in this population”.
Cognitive rehabilitation is consistently recognized as an important
need for people with epilepsy in both clinical practice and in the

https://doi.org/10.1016/j.yebeh.2020.107027
1525-5050/© 2020 Elsevier Inc. All rights reserved.
2 S. Baxendale / Epilepsy & Behavior 106 (2020) 107027

literature, but empirical studies remain rare and currently reviews of
the literature outnumber the original studies they review. This targeted
review has been structured to address the following questions:
a) What are the conceptual and practical barriers to the study of cogni-
tive rehabilitation in epilepsy?
b) How should standardized cognitive rehabilitation programs be
modified to meet the unique challenges of cognitive rehabilitation
in people with epilepsy?
c) Is it possible to conduct preoperative/preemptive rehabilitation
(prehab) for anticipated surgically-induced cognitive deficits in epi-
lepsy surgery candidates?
d) Should rehabilitation programs in epilepsy include lifestyle
modifications?
2. Key questions
2.1. What are the conceptual and practical barriers to the study of cognitive
rehabilitation in epilepsy?
The reasons for the unhelpful publication ratio in original studies:re-
views of cognitive rehabilitation in epilepsy are multiple. Cognitive re-
habilitation is both time and labor intensive, but that is also the case
in other neurological populations such as traumatic brain injury
where original studies abound. The paucity of published studies in epi-
lepsy probably represents the corresponding lack of resources dedi-
cated to treating this aspect of the condition in the clinic. Epilepsy is a
condition defined by the presence of seizures; it is therefore unsurpris-
ing that the majority of financial, clinical, and research resources are fo-
cused on seizure control. However, the revised classification of epilepsy
proposed by the International League Against Epilepsy (ILAE) in 2010
[5] widened the conceptual basis of the diagnosis, recognizing the con-
dition as a network disorder of the brain, where cognitive and behav-
ioral difficulties are seen as essential comorbidities of the condition
[6]. In this framework, the cognitive and behavioral manifestations of
an underlying pathology that predispose someone to have seizures are
often evident on a daily basis, while seizures can be few and far be-
tween. The relatively recent recognition of the essential comorbidities
and wider implications of a diagnosis of epilepsy in our formal classifi-
cation systems may have played a role in the historical neglect of treat-
ments for this aspect of the condition.
It is also the case that many of the treatments prescribed to control
seizures, exacerbate underlying cognitive problems, or create new diffi-
culties. Given the duty of all clinicians to ‘first do no harm’, it is incum-
bent upon us all to actively do everything we can to minimize the
impact of treatments for epilepsy on cognitive function.
Thus, cognitive difficulties can be an integral and pervasive part of
the condition which affects people with epilepsy on a daily basis, and
treatments for seizures can exacerbate these problems. There is there-
fore a clinical, conceptual, and moral basis for the development and im-
plementation of effective interventions to address these issues. The
imperative is particularly strong in epilepsy surgery, an irreversible
treatment with the potential to impact cognitive function for the rest
of someone's life following surgery, regardless of the impact of the treat-
ment on seizure control.
2.2. How should standardized cognitive rehabilitation programs be modi-
fied to meet the unique challenges of cognitive rehabilitation in people with
epilepsy?
Like any neuropsychological intervention in a patient with a neuro-
logical condition, cognitive rehabilitation in epilepsy starts with a thor-
ough neuropsychological assessment which can help to identify the
relative contributions of demographic-, clinical-, and treatment-related
factors to the cognitive impairments identified [7]. However, prior to
the commencement of any cognitive interventions designed to address
these difficulties in someone with epilepsy, it is important to optimize
their seizure control and psychiatric status. This medical preparation
should be an active and integral first stage of the rehabilitation program
and will ensure that the efficacy of any subsequent intervention is opti-
mized. This preparation requires a multidisciplinary approach and will
include discussions about medication choice and compliance and a
comprehensive psychiatric review. Once seizure control and mood are
optimized, the cognitive rehabilitation program can then begin with ed-
ucation on how the brain works and how and why memory fails. When
working with people with epilepsy, this psychoeducation should be
personalized and include information about their seizures, any known
underlying pathology, and the nature of their epilepsy. The important
distinctions between periictal and interictal cognitive disturbance
should be explained. Understanding and accepting that cognitive prob-
lems are an integral part of epilepsy should form the bedrock of any cog-
nitive neurorehabilitation program in people with epilepsy. This
education should be expanded to include friends, family, and employers
where appropriate. When complete, this education in itself can contrib-
ute to a reduction in anxiety which can in turn lead to a reduction in
cognitive complaints prior to any subsequent training in specific cogni-
tive techniques [8].
Specific cognitive interventions can be constructed from the ‘S.O.S’
cognitive rehabilitation toolbox [8] (see Table 1). The first ‘S’ in this ac-
ronym refers to traditional cognitive ‘Strategies’ (for example, method
of loci or visualization). The ‘O’ refers to ‘Outsourcing’ – the outsourcing
of cognitive functions to physical and digital media (pencil and paper
lists, calendars, smart phone apps, etc.). The final ‘S’ in the acronym re-
fers to Social Support. See Baxendale [8] for further details on how to use
the S.O.S toolbox for cognitive rehabilitation in epilepsy.
2.3. Is it possible to conduct preoperative/preemptive rehabilitation
(prehab) for anticipated surgically-induced cognitive deficits in epilepsy
surgery candidates?
2.3.1. The case for prehabilitation in epilepsy surgery candidates
Epilepsy surgery is an elective procedure which involves a complex
decision-making process. An individual contemplating surgery needs
to weigh the chances of gaining a worthwhile reduction in seizures
against the inherent risks associated with the procedure. Some of
these risks are small and essentially associated with ‘something going
wrong’, for example, infection, stroke, or death. However, the chances
of other adverse outcomes can be conceptualized, not so much as a

Table 1
The SOS toolbox.

Strategies a. Internal: traditional methods: method of loci, visualization, etc. Often of limited use in this population because of broader cognitive difficulties.
b. External: environmental adaptions, development of routines, and physical/digital systems to store/check information and deal with incoming information.
Usually more effective than internal strategies.
Outsourcing a. Physical media: pencil and paper, whiteboards, calendars, diaries, etc. Just the act of writing something down means that it is processed more deeply.
b. Digital media: smart phone apps, text reminders, online regular orders, social media to rehearse and autobiographical information, etc.
Social a. Education: teach family, friends, & colleagues about the nature, etiology, and impact of the neuropsychological difficulties associated with epilepsy and its
support treatment and how they can help.
b. Co-opt: use other people's brains when new information comes in, use them to register it for you, e.g., “can you send me an email/text about that”, etc.
 S. Baxendale / Epilepsy & Behavior 106 (2020) 107027
risk, but more as a possible ‘cost’ of surgery since the outcome may be
expected and indeed predicted as a likely postoperative occurrence.
Neuropsychological difficulties would fall into this category of risk (or
cost) associated with epilepsy surgery. People contemplating surgical
treatment need to be given as accurate information as possible about
the likely ‘neuropsychological cost’ of the procedure, if they are to
make an informed decision about surgery [9].
Although the possibility of memory difficulties following temporal
lobe surgery is often acknowledged in the literature, individual cogni-
tive outcomes following epilepsy surgery vary widely. Postoperative
neuropsychological outcomes are determined by a number of clinical
and demographic factors which interact with the side and extent of sur-
gery and other peri- and postoperative factors to shape individual cog-
nitive outcomes.
The likelihoods of postoperative decline based on population studies
of epilepsy surgery patients are variable and are highly dependent on
both the ways in which decline is measured and determined and the
reference population employed. In temporal lobe epilepsy (TLE), post-
operative memory function is essentially a function of the adequacy of
the hippocampus to be resected and the reserve of the structures left
in situ [10]. Factors associated with a high postoperative risk of memory
decline tend to be proxy measures of the hippocampal adequacy/hippo-
campal reserve equation with increased risk of memory decline associ-
ated with indicators of intact function in the structures to be resected. In
addition to performance on traditional neuropsychological tests [11–
14], these indicators include measures from structural magnetic reso-
nance imaging (MRI) [12,13], functional MRI [15–17], positron emission
tomography (PET) and single-photon emission computerized tomogra-
phy (SPECT) [18–20], Wada test performance [11,21–23], and histopa-
thology [24,25]. An increased risk of decline is also associated with
proxy measures of the reduced functional reserve of the whole brain,
not just the contralateral structures in TLE. These include demographic
factors (older age, long duration of epilepsy) [26], clinical variables
(clinical etiology of the seizure disorder, history of generalized seizures
or status epilepticus), and neuropsychological test profiles which indi-
cate widespread cognitive dysfunction [27].
These ‘red flags’ (indications to proceed with caution) can coexist
with protective factors in the same patient. Risk factors and protective
factors have been combined in multivariate models which generate al-
gorithms to predict individual outcomes in specific cognitive domains
following surgery [12,28–30].
Although the majority of the cognitive outcome studies in epilepsy
surgery focus on cognitive decline, up to 20% of people who undergo
temporal lobe surgery experience a significant postoperative improve-
ment in function [31]. These improvements are above and beyond
Fig. 1. Graphical representation of predicted cognitive change following surgery.
3
what would be expected due to regression towards the mean and prob-
ably represent the ‘release’ of function following the removal of inhibi-
tory neurophysiological influences. As with cognitive decline, the
percentage of people who demonstrate a postoperative improvement
is very dependent on the reference group used, but similar multivariate
models can be used to identify the clinical factors associated with these
outcomes and to predict individual outcomes following surgery [31].
Statistical modeling can be used to build a detailed, bespoke picture
of predicted postoperative function, identifying the likelihood of im-
provement, stable function, and decline across a number of cognitive
domains on an individual basis. These predictions can be used in two
important roles in the epilepsy surgery program:
1. To provide an evidence base for discussion of likely neuropsycholog-
ical outcomes in preoperative counseling.
2. To plan and implement prehabilitation (or prehab). While rehabilita-
tion is implemented after a patient has developed a neuropsycholog-
ical deficit, prehabilitation uses intact functions before they are lost,
to get the compensatory strategies and routines in place prior to sur-
gery, in preparation for the anticipated postoperative change.
2.3.2. Planning prehabilitation in epilepsy surgery
The bedrock for prehabilitation in epilepsy surgery patients is a de-
tailed picture of the likely cognitive strengths and weaknesses and
changes in function following surgery. Where available, published algo-
rithms can be used to simulate the likely postoperative picture of func-
tion in language [32] and memory [12,33]. Predictions of deterioration,
improvement, and stable function in multiple cognitive domains can be
represented graphically. See Fig. 1.
These graphical representations of the predicted postoperative cog-
nitive landscape are different for each prospective surgical candidate
and based on their own clinical and neuropsychological characteristics.
The graphs can be used as an evidence base to counsel people with ep-
ilepsy about the likely cognitive costs of the proposed surgery. Bars
above and below the 50% line represent more and less likely outcomes.
These bars can be adjusted to examine likelihoods at different thresh-
olds. These personalized, graphical representations of likely cognitive
change also form a starting point for the prehabilitation process.
However, in many settings, clinicians may not have the necessary
data to either generate their own or use the published predictive algo-
rithms. The creation of accurate predictive models requires data from
a large surgical cohort who have undergone comprehensive pre- and
postoperative neuropsychological follow-up to generate the required
case: variable for adequate sensitivity and specificity. Using published
models from large centers overcomes these issues, but not all centers
have access to the specific information required, particularly where
4 S. Baxendale / Epilepsy & Behavior 106 (2020) 107027

algorithms are based on scores from specific test batteries or unique
functional MRI (fMRI) paradigms. Where algorithms or nomograms
are not available, a more general picture of likely postoperative changes
in function can be created by identifying the presence of ‘red flags’ that
have been highlighted in the literature.
2.3.3. A framework for the prehabilitation of cognitive problems in people
with epilepsy
In the prehabilitation model in epilepsy surgery, the
psychoeducation component is combined with a detailed discussion
and explanation of the likely cognitive changes that are associated with
surgery. It should be stressed that these changes are a consequence of
the surgery regardless of the outcome with respect to seizure control, al-
though acknowledgment that seizure control may modify these changes
should also be part of the discussion [34,35]. While in the presurgical
brain, memory problems may be as much a manifestation of the under-
lying brain condition as seizures in the postsurgical brain cognitive prob-
lems are also associated with the surgery itself. Developing a patient's
understanding and acceptance that cognitive problems may be an inte-
gral consequence of surgery forms the first step in the cognitive
prerehabilitation program in this population. This understanding is es-
sential for the patient to give informed consent to the procedure [9].
Once this understanding is complete, the detailed picture of postop-
erative cognitive strengths and weaknesses and anticipated losses
should be mapped onto the patient's life and expectations of postoper-
ative function. For example, if presurgical investigations indicate that an
individual is at high risk of a postoperative decline in the encoding of
new verbal information, the practical impact of this loss in all aspects
of their life (vocational, domestic, and social) should be explored. This
kind of memory deficit can have a significant impact on someone's abil-
ity to function effectively at work, particularly in an office environment
and in social situations. The aim of this stage in the prehabilitation pro-
cess was to create a comprehensive picture of all of the important areas
in a patient's life where any anticipated cognitive decline may have an
impact. Once these areas have been identified, it is possible to start to
devise a bespoke package of strategies to address these anticipated
difficulties.
The next stage of the prehabilitation program centers around the
creation of a bespoke package of strategies that will reduce the impact
of the postoperative cognitive deficit on everyday function. It must be
stressed that these strategies do not restore the lost function, but rather
they provide an alternative means to an end. They are based on objec-
tives. In this stage of the rehabilitation process, the clinician works
with the patient to devise bespoke solutions to the anticipated postop-
erative problems using techniques from the SOS toolbox.
The final stage of prehabilitation involves the patient practicing
these strategies and getting the necessary routines in place prior to sur-
gery so that they are already familiar with and using the tools that they
will need after surgery. For many people, the cognitive difficulties that
they experience following surgery are an exacerbation of the problems
they have beforehand, so they do not have to wait for surgery to feel the
benefits of prehabilitation (Table 2).
2.4. Should rehabilitation programs in epilepsy include lifestyle
modifications?
It is now well established that obesity in middle age and beyond may
be associated with accelerated cognitive aging in nonneurological pop-
ulations [36]. In nonsurgical populations with epilepsy, Body Mass
Index (BMI) accounts for a significant proportion of the variance in pro-
cessing speed and is significantly correlated with memory function with
poorer scores associated with higher BMIs, even when educational level
and socioeconomic status are controlled for [37]. There is some evidence
that cognitive under function associated with a high BMI may be ame-
liorated following lifestyle changes promoting fitness and weight loss
in the general population [38]. It is unknown whether cognitive im-
provements would also be seen in people with epilepsy who implement
beneficial lifestyle changes. Optimizing physical condition prior to sur-
gery should be an integral part of any preoperative preparation, but
this is rarely an explicit part of the path towards epilepsy surgery. It is,
however, possible that lifestyle advice and guidance may also confer
cognitive benefits in addition to optimizing fitness for surgery. Further
research is required to examine this intriguing possibility but is possible
that lifestyle advice may become an integral part of the cognitive reha-
bilitation and prehabilitation process in the future.
3. Summary
Treatments of epilepsy aimed solely at controlling seizures do not
address the full spectrum of difficulties associated with the condition.
Neuropsychological difficulties are now recognized as an essential co-
morbidity and can be exacerbated further by treatments aimed at stop-
ping seizures. When they are present, some attempt to address
cognitive problems should form an integral part of the holistic treat-
ment for someone with epilepsy.
People considering epilepsy surgery are unique in the neurological
population in that we now have empirical techniques to predict the na-
ture and extent of the likely cognitive changes associated with the sur-
gery, before they occur. Discussion of the likely postoperative cognitive
landscape is an integral part of the preparation of surgical candidates.
Potential candidates are unable to give informed consent to surgical
treatment without this information. In addition to forming the empirical
basis for informed consent, predictions of postoperative cognitive
change also allow for the design and implementation of prehabilitation
programs to prepare an individual for expected changes as part of the
presurgical workup. The prehabilitation approach utilizes an individu-
al's preoperative abilities to embed the strategies and routines they
will require to compensate for predicted postoperative changes in cog-
nitive function, prior to surgery. The prehabilitation approach repre-
sents personalized medicine in the epilepsy surgery setting. The
program is personalized to harness strengths before they are lost and
to create practical solutions to the anticipated problems that these
losses may occur in all aspects of an individual's life, with the person
with epilepsy very much at the forefront of setting the priorities in the
program.

Table 2
Stages in the prehabilitation processes in epilepsy surgery.

Step 1: Creation of the likely postoperative
cognitive profile
Step 2: Feedback and education
Step 3: Mapping of the anticipated deficits onto
function in the real world
Step 4: Creation of a bespoke package of solutions
using the SOS toolbox
Step 5: Implement prehabilitation
Ideally using multivariate models of prediction or nomograms
The presence of clinical ‘red flags’ that are associated with a high risk of postoperative decline can also contribute to this
picture
Explanation of the basis of pre- and postoperative cognitive difficulties. Explanation that the postoperative cognitive
profile may be the ‘cost’ of surgery, regardless of the outcome in terms of seizure freedom
Detailed examination of the likely impact of the anticipated cognitive decline on all areas of the patient's life.
Put together an individualized package of strategies from the SOS toolbox for each anticipated area of difficulty, with
reference to all resources (internal and external) available to the person with epilepsy.
Implement the strategies and routines prior to surgery so that the patient is already familiar with the strategies and has
supportive routines in place prior to the operation. Prioritize goals. It is usually best to start with something simple that has
a high chance of success to build up a positive cycle of confidence and expectation.
 S. Baxendale / Epilepsy & Behavior 106 (2020) 107027
Funding
This research did not receive any specific funding.
Declaration of competing interest
Dr. Baxendale serves as the chair of the ILAE Neuropsychology Task
Force 2017–2021 and on the UK ILAE Executive Committee. She has re-
ceived payment for expert testimony for the UK Courts.
Key questions (answered)
1. What are the conceptual and practical barriers to the study
of cognitive rehabilitation in epilepsy?
Cognitive and behavioral difficulties have only been recognized as
essential comorbidities of epilepsy relatively recently in formal
classifications of the condition. Neuropsychological difficulties
are often manifestations of the same underlying brain pathology
that predisposes someone to having seizures. A narrow focus on
seizures as the only manifestation of epilepsy has resulted in a
paucity in the development of treatments aimed at ameliorating
neuropsychological aspects of the condition.
2. How should standardized cognitive rehabilitation programs
be modified to meet the unique challenges of cognitive re-
habilitation in people with epilepsy?
Preparation is the key here. Understanding and accepting that
cognitive problems are an integral part of epilepsy should form
the bedrock of any cognitive neurorehabilitation program in people
with epilepsy. This education should be expanded to include
friends, family, and employers where appropriate. When com-
plete, this psychoeducation in itself can contribute to a reduction
in anxiety which can in turn lead to a reduction in cognitive com-
plaints, prior to any subsequent training in specific cognitive
techniques.
3. Is it possible to conduct preoperative/preemptive rehabilita-
tion (prehab) for anticipated surgically-induced cognitive
deficits in epilepsy surgery candidates?
In theory, yes. Nomograms and algorithms have now been pub-
lished which allow clinicians to create an accurate picture of likely
postoperative changes in cognitive function in a number of do-
mains. These predictions can be used to plan and implement
prehabilitation (or prehab) using intact functions before they are
lost, to help fix the compensatory strategies and routines in place
prior to surgery, in preparation for the anticipated postoperative
change.
4. Should rehabilitation programs in epilepsy include lifestyle
modifications?
Obesity in middle age and beyond is associated with accelerated
cognitive aging in nonneurological populations. In epilepsy popula-
tions, BMI accounts for a significant proportion of the variance in
processing speed and is significantly correlated with memory
function. There is some evidence that cognitive under function as-
sociated with a high BMI may be ameliorated following lifestyle
changes promoting fitness and weight loss in the general
5
population. It is unknown whether cognitive improvements would
also be seen in people with epilepsy who implement beneficial life-
style changes, but this represents a possible new treatment ave-
nue for cognitive difficulties in this group.
References
[1] Farina E, Raglio A, Giovagnoli AR. Cognitive rehabilitation in epilepsy: an evidence-
based review. Epilepsy Res 2015;109(1):210–8 [Internet]. [cited 2020 Feb 29]. Avail-
able from: http://www.ncbi.nlm.nih.gov/pubmed/25524861.
[2] Mazur-Mosiewicz A, Carlson HL, Hartwick C, Dykeman J, Lenders T, Brooks BL, et al.
Effectiveness of cognitive rehabilitation following epilepsy surgery: current state of
knowledge. Epilepsia 2015;56(5):735–44 [Internet]. [cited 2018 Jul 30]. Available
from: http://www.ncbi.nlm.nih.gov/pubmed/25809562.
[3] Del Felice A, Alderighi M, Martinato M, Grisafi D, Bosco A, Thompson PJ, et al. Mem-
ory rehabilitation strategies in nonsurgical temporal lobe epilepsy: a review. Am J
Phys Med Rehabil 2017;96(7):506–14 [Internet]. [cited 2019 Dec 25]. Available
from: http://www.ncbi.nlm.nih.gov/pubmed/28628538.
[4] Leeman-Markowski BA, Schachter SC. Treatment of cognitive deficits in epilepsy.
Neurol Clin 2016;34(1):183–204 [Internet]. cited 2020 Feb 29. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/26613999.
[5] Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, et al. Re-
vised terminology and concepts for organization of seizures and epilepsies: report of
the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia 2010;
51(4):676–85 [Internet]. cited 2017 Mar 27. Available from: http://doi.wiley.com/
10.1111/j.1528-1167.2010.02522.x.
[6] Wilson SJ, Baxendale S. Reprint of: the new approach to classification: rethinking
cognition and behavior in epilepsy. Epilepsy Behav, vol. 64. Academic Press Inc.;
2016. p. 300–3.
[7] Wilson SJ, Baxendale S, Barr W, Hamed S, Langfitt J, Samson S, et al. Indications and
expectations for neuropsychological assessment in routine epilepsy care: report of
the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013-
2017. Epilepsia 2015;56(5):674–81.
[8] Baxendale S. Populations referred for neuropsychological rehabilitation: epilepsy. In:
Wilson Barbara A, Winegardener Jill, van Heugten Caroline, O T, editors. Neuropsy-
chological rehabilitation: the international handbook. Abingdon, Oxon: Taylor &
Francis; 2017. p. 77–80.
[9] Baxendale S. Managing expectations of epilepsy surgery. Long-term outcomes of ep-
ilepsy surgery in adults and children; 2015.
[10] Chelune GJ. Hippocampal adequacy versus functional reserve: predicting memory
functions following temporal lobectomy. Arch Clin Neuropsychol 1995;10(5):
413–32 [Internet]. cited 2017 May 9. Available from: http://www.ncbi.nlm.nih.
gov/pubmed/14588901.
[11] Davies KG, Bell BD, Bush AJ, Wyler AR. Prediction of verbal memory loss in individ-
uals after anterior temporal lobectomy. Epilepsia 1998;39(8):820–8 [Internet]. cited
2019 Jul 5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9701371.
[12] Baxendale S, Thompson P, Harkness W, Duncan J. Predicting memory decline follow-
ing epilepsy surgery: a multivariate approach. Epilepsia 2006;47(11):1887–94 [In-
ternet]. cited 2017 Apr 29. Available from: http://www.ncbi.nlm.nih.gov/pubmed/
17116029.
[13] Lineweaver TT, Morris HH, Naugle RI, Najm IM, Diehl B, Bingaman W. Evaluating the
contributions of state-of-the-art assessment techniques to predicting memory out-
come after unilateral anterior temporal lobectomy. Epilepsia 2006;47(11):
1895–903 [Internet]. cited 2019 Jul 5. Available from: http://www.ncbi.nlm.nih.
gov/pubmed/17116030.
[14] Harvey DJ, Naugle RI, Magleby J, Chapin JS, Najm IM, Bingaman W, et al. Relationship
between presurgical memory performance on the Wechsler Memory Scale-III and
memory change following temporal resection for treatment of intractable epilepsy.
Epilepsy Behav 2008;13(2):372–5 [Internet]. cited 2019 Jul 5. Available from:
https://linkinghub.elsevier.com/retrieve/pii/S1525505008001042.
[15] Sidhu MK, Stretton J, Winston GP, Symms M, Thompson PJ, Koepp MJ, et al. Memory
fMRI predicts verbal memory decline after anterior temporal lobe resection. Neurol-
ogy 2015;84(15):1512–9 [Internet]. cited 2019 Jul 5. Available from: http://www.
neurology.org/cgi/doi/10.1212/WNL.0000000000001461.
[16] Bonelli SB, Powell RHW, Yogarajah M, Samson RS, Symms MR, Thompson PJ, et al.
Imaging memory in temporal lobe epilepsy: predicting the effects of temporal
lobe resection. Brain 2010;133(Pt 4):1186–99 [Internet]. cited 2019 Jul 5. Available
from: https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/awq006.
[17] Richardson MP, Strange BA, Thompson PJ, Baxendale SA, Duncan JS, Dolan RJ. Pre-
operative verbal memory fMRI predicts post-operative memory decline after left
temporal lobe resection. Brain 2004;127(11).
[18] Parra-Díaz P, García-Casares N. Memory assessment in patients with temporal lobe
epilepsy to predict memory impairment after surgery: A systematic review.
Neurologia 2019 Nov - Dec;34(9):596–606. https://doi.org/10.1016/j.nrl.2017.02.
012 Epub 2017 Apr 19. Review. English, Spanish. PubMed PMID: 28433263.
[19] Leeman BA, Leveroni CL, Johnson KA. Does hippocampal FDG-PET asymmetry pre-
dict verbal memory dysfunction after left temporal lobectomy? Epilepsy Behav
2009;16(2):274–80 [Internet]. cited 2019 Jul 5. Available from: http://www.ncbi.
nlm.nih.gov/pubmed/19726233.
6 S. Baxendale / Epilepsy & Behavior 106 (2020) 107027
[20] Hanoğlu L, Ozkara C, Keskinkiliç C, Altin U, Uzan M, Tuzgen S, et al. Correlation be-
tween 1H MRS and memory before and after surgery in mesial temporal lobe epi-
lepsy with hippocampal sclerosis. Epilepsia 2004;45(6):632–40 [Internet]. cited
2019 Jul 5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15144428.
[21] Mani J, Busch R, Kubu C, Kotagal P, Shah U, Dinner D. Wada memory asymmetry
scores and postoperative memory outcome in left temporal epilepsy. Seizure
2008;17(8):691–8 [Internet]. cited 2019 Jul 5. Available from: https://linkinghub.
elsevier.com/retrieve/pii/S1059131108000976.
[22] Kneebone AC, Chelune GJ, Dinner DS, Naugle RI, Awad IA. Intracarotid amobarbital
procedure as a predictor of material-specific memory change after anterior temporal
lobectomy. Epilepsia 1995;36(9):857–65 [Internet]. cited 2019 Jul 5. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/7649125.
[23] Baxendale S, Thompson P, Harkness W, Duncan J. The role of the intracarotid amo-
barbital procedure in predicting verbal memory decline after temporal lobe resec-
tion. Epilepsia 2007;48(3).
[24] Sass KJ, Spencer DD, Kim JH, Westerveld M, Novelly RA, Lencz T. Verbal memory im-
pairment correlates with hippocampal pyramidal cell density. Neurology 1990;40
(11):1694–7 [Internet]. cited 2018 Jul 30. Available from: http://www.ncbi.nlm.
nih.gov/pubmed/2234424.
[25] Baxendale SA, Van Paesschen W, Thompson PJ, Duncan JS, Harkness WF, Shorvon
SD. Hippocampal cell loss and gliosis: relationship to preoperative and postoperative
memory function. Neuropsychiatry Neuropsychol Behav Neurol 1998;11(1):12–21
[Internet]. cited 2017 May 9. Available from: http://www.ncbi.nlm.nih.gov/
pubmed/9560824.
[26] Lang JD, Grell L, Hagge M, Onugoren MD, Gollwitzer S, Graf W, et al. Long-term out-
come after epilepsy surgery in older adults. Seizure 2018;57:56–62 [Internet]. cited
2019 Jul 5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29604610.
[27] Baxendale S, Thompson P. Red flags in epilepsy surgery: Identifying the patients
who pay a high cognitive price for an unsuccessful surgical outcome. Epilepsy
Behav 2018 Jan;78:269–72. https://doi.org/10.1016/j.yebeh.2017.08.003 Epub
2017 Nov 5. PubMed PMID: 29117924.
[28] Busch RM, Hogue O, Kattan MW, Hamberger M, Drane DL, Hermann B, et al. Nomo-
grams to predict naming decline after temporal lobe surgery in adults with epilepsy.
Neurology 2018;91(23):e2144–52 [Internet]. cited 2019 Jul 5. Available from:
http://www.neurology.org/lookup/doi/10.1212/WNL.0000000000006629.
[29] Keary TA, Frazier TW, Busch RM, Kubu CS, Iampietro M. Multivariate neuropsycho-
logical prediction of seizure lateralization in temporal epilepsy surgical cases.
Epilepsia 2007;48(8):1438–46 [Internet]. cited 2019 Jul 5. Available from: http://
doi.wiley.com/10.1111/j.1528-1167.2007.01098.x.
[30] Busch RM, Hogue O, Kattan MW, Hamberger M, Drane DL, Hermann B, et al. Nomo-
grams to predict naming decline after temporal lobe surgery in adults with epilepsy.
Neurology 2018;91(23):e2144–52 [Internet]. cited 2019 Jul 5. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/30404781.
[31] Baxendale S, Thompson PJ, Duncan JS. Improvements in memory function following
anterior temporal lobe resection for epilepsy. Neurology 2008;71(17).
[32] Busch RM, Frazier TW, Haggerty KA, Kubu CS. Utility of the Boston Naming Test in
predicting ultimate side of surgery in patients with medically intractable temporal
lobe epilepsy. Epilepsia 2005;46(11):1773–9 [Internet]. cited 2019 Jul 5. Available
from: http://www.ncbi.nlm.nih.gov/pubmed/16302857.
[33] Ljunggren S, Andersson-Roswall L, Imberg H, Samuelsson H, Malmgren K. Predicting
verbal memory decline following temporal lobe resection for epilepsy. Acta Neurol
Scand 2019 Nov;140(5):312–9. https://doi.org/10.1111/ane.13146 Epub 2019 Jul
30. PubMed PMID: 31273754.
[34] Baxendale S, Wilson SJ, Baker GA, Barr W, Helmstaedter C, Hermann BP, Langfitt J,
Reuner G, Rzezak P, Samson S, Smith ML. Indications and expectations for neuropsy-
chological assessment in epilepsy surgery in children and adults: Executive sum-
mary of the report of the ILAE Neuropsychology Task Force Diagnostic Methods
Commission: 2017-2021. . 9Epilepsia, 60; 2019 Sep; 1794–6. https://doi.org/10.
1111/epi.16309 Epub 2019 Aug 11. PubMed PMID: 31402443.
[35] Helmstaedter C, Elger CE, Vogt VL. Cognitive outcomes more than 5 years after tem-
poral lobe epilepsy surgery: remarkable functional recovery when seizures are con-
trolled. Seizure 2018;62:116–23 [Internet]. cited 2019 Jul 5. Available from: http://
www.ncbi.nlm.nih.gov/pubmed/30359865.
[36] Farruggia MC, Small DM. Effects of adiposity and metabolic dysfunction on cogni-
tion: a review. Physiol Behav 2019;208:112578 [Internet]. cited 2019 Jul 5. Available
from: http://www.ncbi.nlm.nih.gov/pubmed/31194997.
[37] Baxendale S, McGrath K, Donnachie E, Wintle S, Thompson P, Heaney D. The role of
obesity in cognitive dysfunction in people with epilepsy. Epilepsy Behav 2015;45.
[38] Erickson KI, Voss MW, Prakash RS, Basak C, Szabo A, Chaddock L, et al. Exercise train-
ing increases size of hippocampus and improves memory. Proc Natl Acad Sci U S A
2011;108(7):3017–22 [Internet]. cited 2019 Jul 5. Available from http://www.ncbi.
nlm.nih.gov/pubmed/21282661.