Unexpected loss of brain power in epilepsy

In severe epilepsy, only surgery can often help – usually with great success. While brain performance can recover long-term after successful surgery, in rare cases, an unexpected decline in cognitive performance can occur. Scientists from the University of Bonn have now succeeded in proving which patients are particularly at risk. Their results were published in the journal Annals of Neurology. They could help identify affected individuals for whom surgery should be avoided. Instead, new treatment perspectives are emerging for sufferers.

Epilepsy cannot always be controlled with medication. In these cases, the disabled should find out whether surgery is possible. During the procedure, surgeons remove the damaged brain tissue that is the source of the seizures. The result is often a complete cure of the patients.

“The operation revolutionized the treatment of severe epilepsy,” explains Dr. Juri-Alexander Witt, private lecturer at the Clinic for Epileptology of the University Hospital Bonn. “However, there is always a risk of cognitive impairment with epilepsy surgery. However, long-term studies have shown that brain performance can be restored for a long time after a successful operation.”

Unexpected declines in performance one month after the procedure

However, for a small part of those affected, unexpected decreases in performance do not occur until months or years after the operation. “We wanted to know why this is so,” says Annika Reimers, PhD student at the Institute of Neuropathology in Prof. Dr. Albert Becker.

The scientists were helped by the University Hospital Bonn’s long-term experience in epilepsy surgery: They were able to rely on brain tissue samples, some of which were taken decades ago. “We analyzed a total of 24 samples from men and women who were found to have severe cognitive impairment several months or even years after surgery,” explains Reimers.

The researchers encountered an anomaly: the tissue taken from the sufferer had been damaged by a secondary disease at the time of surgery – either inflammation or changes that occur in the early stages of dementia. “In the case of these pre-existing conditions, the body’s own defenses are particularly active,” says Becker, who is also a member of the Transdisciplinary Research Center (TRA) “Life and Health”. “It is possible that trauma during surgery further stimulates the immune system in the brain to attack healthy brain tissue.”

The tests provide clues as to when surgery should be avoided

The researchers now want to examine samples from other epilepsy centers to substantiate their findings. The results could help identify affected individuals in whom surgery should be avoided. “Today we have at hand various diagnostic methods that we can use for this purpose,” emphasizes Dr. Juri-Alexander Witt.

Before surgery, all patients complete an extensive battery of psychometric tests to determine their cognitive performance. In the overview of brain scanner records and examination of cerebrospinal fluid through spinal puncture, some results already allow conclusions to be drawn about accompanying diseases. “If such tests indicate inflammation or incipient neurodegenerative disease, there are entirely new treatment options—such as anti-inflammatory drugs—that may make surgery unnecessary,” says Becker.

The study was funded by the German Research Foundation (DFG) and the Elsa Kröner-Fresenius Foundation within the PhD program Neuroimmunology.

Scientific contacts:

PD Dr. Juri-Alexander Witt
Clinic and Polyclinic for Epileptology, University Hospital Bonn
Tel. +49 (0)228-287-14436
Email: juri-alexander.witt@ukbonn.de

Prof. Dr. Albert Becker
Department of Neuropathology at the University Hospital in Bonn
Tel. +49 (0)228-287-11352
Email: albert_becker@uni-bonn.de

Original publication:

Annika Reimers, Christoph Helmstaedter, Christian E. Elger, Julika Pitsch, Motaz Hamed, Albert J. Becker and Juri-Alexander Witt: Neuropathological insights into unexpected cognitive decline in epilepsy; Annals of Neurology; DOI:


literature on the topic

Gerd Heinen and others: Custom Actions in Seizures Book 1-12

Ratgeber Epilepsy patients

Pabst, 2021

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