Cognitive rehabilitation and prehabilitation in people with epilepsy.

Epilepsy is now recognized as a network disorder of the brain that can impact cognition beyond the periictal disturbance associated with seizures. While there is a large literature on the assessment of cognitive functions, particularly memory, in people with epilepsy, there are far fewer studies looking at the efficacy of treatments for cognitive dysfunction in this population. Reviews of the cognitive rehabilitation literature in epilepsy have begun to outnumber original studies. This paper examines the possible reasons for this unsatisfactory ratio in the literature and examines the unique challenges and opportunities for cognitive rehabilitation in this population, with a particular focus on epilepsy surgical candidates. The concept of prehabilitation in this population is described. While traditional cognitive rehabilitation is implemented after a patient has developed a neuropsychological deficit, in surgical candidates, prehabilitation uses intact functions before they are lost to establish compensatory strategies and routines prior to surgery in preparation for postoperative changes. The likely postoperative 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 cognitive difficulties in both surgical and nonsurgical populations of people with epilepsy.