Pre- and postoperative cognitive function scores in resective and destructive surgeries for pharmacoresistant epilepsy (as assessed by MoCA)
Authors:   Polenov Neurosurgical Institute — branch of the Federal State Budgetary Institution «Almazov National Medical Research Center» of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russia, Shalygin D. Yu. , Ivanova N. E. ,   Polenov Neurosurgical Institute — branch of the Federal State Budgetary Institution «Almazov National Medical Research Center» of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russia, Dengina N. O. ,   Polenov Neurosurgical Institute — branch of the Federal State Budgetary Institution «Almazov National Medical Research Center» of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russia, Abramov K. B. ,   Polenov Neurosurgical Institute — branch of the Federal State Budgetary Institution «Almazov National Medical Research Center» of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russia, Odintsova G. V. ,   Polenov Neurosurgical Institute — branch of the Federal State Budgetary Institution «Almazov National Medical Research Center» of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russia
Published: December 2024

Epilepsy is associated with comorbid diseases and cognitive impairment, which, even with
successful compensation of seizures by medication and/or surgery, continue to have a negative impact on
the quality of life of patients. The cognitive outcomes of surgery are variable: they may include positive
changes or no changes, but there is also a risk of increasing cognitive dysfunction.
Purpose of the study. To ascertain the impact of resective and destructive surgeries in pharmacoresistant epilepsy on cognitive functions, as assessed using the Montreal Cognitive Assessment (MoCA) screening scale.
Materials and Methods. The article presents the results of an investigation into the impact of resective and
destructive surgeries in pharmacoresistant epilepsy on cognitive functions, as assessed by the MoCA. The
study comprised 50 patients with a verified diagnosis of focal pharmacoresistant epilepsy, divided into two groups: group 1 (25 patients) underwent resective surgery, while group 2 (25 patients) had destructive
surgery. Cognitive function was evaluated using the Montreal Cognitive Assessment Scale (MoCA) prior to
surgery and at intervals between six months and five years post-operatively.
Results. The mean age of the subjects at the time of surgery was 33.2 ± 10.05 years, and the mean duration of epilepsy was 20.7 ± 10.98 years. In 50 % of patients, the epileptic focus was localized to the left side
of the brain, while in 44 % of cases, it was localized to the right side. In 6 % of patients, the epileptic focus was bilateral. The majority of patients (70 %) exhibited temporal epilepsy, while 18 % demonstrated extratemporal epilepsy and 4 % showed both temporal and extratemporal epilepsy. At the preoperative stage, cognitive deficit was observed in the majority of patients (76 %), with an average score of 23.1
points. In the postoperative period, cognitive impairment was also observed in 76 % of patients, with no
change in the mean MoCA score of 23.1. In group 1, 80 % of patients exhibited cognitive deficits prior to the operation, with an average score of 22.2. In the postoperative period, the score showed an increase, reaching 23.4. In group 2, cognitive deficit was also observed in the majority of patients (72 %) at the
preoperative stage. The average score in group 2 was 21.7 points, which increased to 22.2 points after
the operation.
Conclusion. The practice of delaying surgical treatment for pharmacoresistant epilepsy persists, with
cognitive functions preserved at the time of hospitalization in only a quarter of patients. The mean score
on the Cognitive Function Assessment Screening Scale did not decline as a result of surgical intervention. However, a negative effect was observed in patients who did not show cognitive deficits prior to surgery. The findings will assist physicians in making informed decisions regarding the timing and approach to pharmacoresistant epilepsy treatment.