Epilepsy and mental decline.

Experience with prolonged seizures in animal models and humans teaches that cellular injury and cognitive impairment can occur in epilepsy. Status epilepticus probably causes cerebral injury and cognitive dysfunction if it is of long duration; however, studies of electroconvulsive therapy do not support the idea that repeated seizures alone produce a decline in cognitive function. Although many factors related to seizures may correlate with cognitive impairment in certain groups of patients with epilepsy, prospective studies do not support the premise that cognitive impairment develops or progresses in a population of epilepsy patients. When impairment is present, its origin appears to be multifactorial. In addition to the seizures and associated seizure variables (including anticonvulsant medications), interictal epileptiform discharges and the perceptions of the patients and others also may play major roles.