Response to: Translational considerations in epilepsy surgery: Linking longitudinal cognitive phenotyping with epigenetic hypotheses

Dear Editor-in-Chief, I was pleased to read the positive feedback from Dr. Cristian Blanco-Inostroza on our paper on the diagnostic challenges in the neuropsychology of epilepsy.1 He mentions what appears to him to be a clinical paradox, that patients who undergo epilepsy surgery and achieve an excellent outcome with respect to seizure control nonetheless do not demonstrate what he terms “the anticipated trajectory of cognitive recovery.” It is recognized that postoperative cognitive function is influenced by whether the resected tissue had or had not still subserved function, and the functional reserve of the structures spared in the resection.2 It should also be noted that all the factors described in the diagnostic challenges paper can also influence the trajectory of neuropsychological outcome after surgery and thus must also be addressed in the ongoing care of the patient to optimize cognition, behavior, and psychosocial function. Dr. Blanco-Inostroza recommends the longitudinal application of the standardized taxonomy proposed in the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE)3 as a method to understand the evolution of cognitive phenotypes after surgery, and specifically that it be used in conjunction with efforts to identify molecular mechanisms underlying the limits of cognitive recovery. Research with the IC-CoDE in temporal lobe epilepsy has shown that psychiatric factors are not only associated with function in specific cognitive domains but also with the pattern and extent of deficits across cognitive domains.4 Given that psychiatric symptoms often persist or even worsen after surgery suggests that using the IC-CoDE longitudinally to address these and other variables associated with complex patterns of neuropsychological function can be helpful in mapping surgical outcomes. The author has no conflicts of interest to declare. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.