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morbidity prior to surgery, determine adequacy of consent, identify treatable psychiatric
conditions that may require separate interventions and to flag up patients who may need
additional psychiatric support peri- and post-operatively.

Neuropsychological assessment is also used to estimate the psychological sequelae of
epilepsy surgery. This is frequently used to estimate the possible deterioration in memory
that will occur with temporal lobe resection. The use of the intracarotid sodium amytal test
in patients undergoing temporal lobe resection is diminishing, because of concerns about its
accuracy and usefulness in predicting memory decline following surgery. At the National
Hospital, we have largely abandoned this test. It is still used in some centres, however, to test
patients in whom there is discordance between neuropsychometric testing and neuroimaging
and in whom an operation is thought to have a reasonable chance of success. fMRI is
increasingly being used to lateralise language function, and may in the future also be used to
help with memory lateralisation.

Details of risk-benefit discussions with the patient and family need to be recorded in the
patient notes and given to the patient in writing. This information should include an estimate
of the chances of operative success, along with the risks of complications from the operation
(including the risks of permanent neurological sequelae) and the impact that these will have
on the patient’s lifestyle. Information on the potential psychiatric and psychological sequelae
also needs to be given. Pre- and peri-operative counselling is crucial for all patients
undergoing epilepsy neurosurgery.

Further reading

SHORVON S, PERUCCA E, ENGEL J et al (2009) Treatment of Epilepsy (3rd Edition). Wiley-Blackwell, Oxford.