UCL, Queen Square Institute of Neurology, London, UK.
Curr Opin Neurol. 2020 Apr;33(2):207-212. doi: 10.1097/WCO.0000000000000799.
Access to epilepsy surgery is rapidly growing throughout the world. While it is an established and effective treatment for seizures, epilepsy surgery has the potential to exacerbate cognitive comorbidities of the condition.
Not all surgical patients experience a postoperative decline in cognitive function. Postoperative cognitive function depends upon the functional integrity of the tissue to be removed and the functional reserve of the structures that remain in situ. While developments in surgical technique can reduce the cognitive morbidity of epilepsy surgery, the same procedure may result in different cognitive outcomes for different candidates, depending on their preoperative characteristics and postoperative trajectories. Multivariate models can be used to identify those most at risk of cognitive decline. There remains a significant lack of research into clinical interventions aimed at reducing the impact of surgically induced cognitive deficits on the lives of the patients who experience them.
Accurate identification of the cognitive risks associated with surgery, based on an individual's personal risk profile rather than the generic risks associated with the procedure, is now recognized as a mandatory part of the preoperative evaluation and is one of the pillars of informed consent for the procedure.
世界各地癫痫手术的应用正在迅速发展。尽管癫痫手术是一种成熟且有效的治疗方法，但它也有可能加重该疾病的认知合并症。
并非所有接受手术的患者都会在手术后认知功能下降。术后认知功能取决于要切除的组织的功能完整性和原位保留的结构的功能储备。虽然手术技术的发展可以降低癫痫手术的认知发病率，但相同的手术程序可能会导致不同的患者产生不同的认知结果，这取决于他们的术前特征和术后轨迹。多变量模型可用于识别那些认知下降风险最高的患者。目前，针对旨在减少手术引起的认知缺陷对经历这些缺陷的患者生活影响的临床干预措施，仍缺乏大量研究。
现在，基于个体的个人风险概况而不是与手术相关的一般风险，准确识别与手术相关的认知风险，已被认为是术前评估的强制性部分，也是该手术知情同意的支柱之一。
