Cognitive impairment (CI) is a common comorbid pathology in epilepsy patients that exerts profound negative impact on quality of life. The CI causes may be due to various factors related to etiology, clinical manifestations, and treatment of epilepsy. A typical disorder in temporal lobe epilepsy is memory impairment. However, neuropsychological impairments may be more extensive and involve other neuropsychological domains. The risk of CI in patients with temporal lobe epilepsy may increase in structural brain disorders such as hippocampal sclerosis as well as in frequent seizures, early onset and long course of the disease. Surgical treatment of epilepsy may positively or negatively impact the cognitive function. In recent years, due to development of neurosciences as well as advances in the field of medical technologies, particularly neuroimaging, genetics, immunology, and biochemistry, new data emerged regarding potential mechanisms for developing CI in patients with epilepsy. The aim of the review is to assess available ideas about neurophysiological mechanisms of CI development, cues influencing emergence of neuropsychological disorders in patients with temporal lobe epilepsy.
The review provides historical information on the medical use of cannabinoids from antiquity to the present day. It presents the most common indications for their use in neurology, oncology, and psychiatry for the treatment of social diseases, such as epilepsy, pain syndromes, spasticity, including multiple sclerosis, Parkinson's disease, depression, schizophrenia, dementia, etc. There are data of the largest-scale and evidence-based studies using cannabinoids to treat epilepsy. The paper depicts the main mechanisms of action of these drugs and gives information about their efficacy and safety, as well as possible adverse events. Limitations and legal aspects are discussed. Systematic reviews and meta-analyses show that today there have been sufficient positive study results worldwide, indicating the validity of the medical use of cannabinoids. At the same time, experimental and clinical studies are needed to further investigate the mechanisms of action of cannabinoids, the characteristics of their pharmacokinetics and pharmacodynamics, efficacy and safety for many severe and disabling diseases.
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