Comprehensive postictal neuropsychology improves focus localization in epilepsy

In recent years, new techniques such as single photon emission computed tom ography (SPECT), positron emission tomography (PET) and magnetic resonance imaging (MRI) have been used to improve the localization of epileptic foci during the noninvasive evaluation procedure for epilepsy surgery. Since ict al/or immediate postictal SPECT studies were shown to localize epileptic fo ci better than interictal SPECT, we addressed the question of whether immed iate postictal neuropsychological examination would show the same effect. N europsychological examinations were carried out postictally and interictall y using a broad range of tests. Postictal results were analyzed with regard to lateralizing and localizing information about the epileptogenic region. Seventeen patients suffering from temporal and extratemporal pharmacoresis tant epilepsy were investigated postictally with a subset of tests used for the interictal neuropsychological examination. A significant improvement i n focus localization was seen in comparison with interictal neuropsychology (p = 0.014). We conclude that neuropsychology can yield lateralizing and s ometimes localizing information, even for extratemporal foci, if carried ou t during the postictal period and based on a global analysis of the clinica l neuropsychological picture.