Abstract: The impact of epilepsy surgery on quality of life and neuropsychological aspects is poorly understood in China. In this paper, we conducted a more comprehensive literature review on the changes in quality of life and neuropsychological aspects of patients after anterior temporal lobectomy, extratemporal lobectomy, vagus nerve stimulation, corpus callosotomy, and radiation therapy for epilepsy. A summary of the literature revealed that although the reported results on the effects of epilepsy surgery on quality of life and neuropsychological function vary, most of the literature shows that significant quality of life improvement and neuropsychological function improvement may be obtained after epilepsy surgery, especially in those with well-controlled postoperative epilepsy, pediatric patients, and those undergoing palliative surgery. Some drug-refractory epilepsies can be reduced or controlled by surgical intervention and may reduce or discontinue drug therapy. The largest surgical outcome reported by Engle et al. showed that 3,579 patients with anterior temporal lobectomy (ATL) had 67.9% seizure free (SF), 24.0% improvement, 8.1% ineffectiveness, and a mortality rate of less than 1%. . However, a complete assessment of the surgical outcome of epilepsy should include not only seizure control and surgical complications, but also quality of life (QOL) and neuropsychological assessment (NPA). Patients with epilepsy often have a combination of mental retardation, behavioral problems, depression, and other psychological problems, low employment and school attendance, and significantly lower QOL. There are several possible reasons for these problems: first, the structural or functional brain damage that causes epilepsy may also cause, for example, mental retardation (material basis); second, recurrent seizures, epileptiform discharges without clinical seizures, and long-term medication may cause or exacerbate cognitive and brain function impairment with behavioral abnormalities; in addition, some AEDs also have the potential to cause affective disorders and behavioral abnormalities. The development of long-term NPA impairment in epilepsy surgery, whether in the elderly, children or adults, is one of the major concerns of families and patients. Therefore, both preoperative evaluation and postoperative outcome evaluation of epilepsy surgery should take QOL and NPA into account. I. Changes in QOL and NPA after resective epilepsy surgery 1. The postoperative attention improved in 32.4% and decreased in 26.5% of the patients, while the verbal memory (VM) and visual spatial memory (VSM) levels increased in none of the patients older than 60 years, and decreased in 75% and 37.5%, respectively, which were significantly different from the younger age group. 45 years old epilepsy surgery patients, after surgery 25 cases felt no cognitive changes, 7 cases felt better than before surgery, while 10 cases decreased. The QOL scores improved significantly or to some extent in 34 cases, no change in 7 cases, and only 1 case showed a mild decline. this author concluded that postoperative cognitive and neuropsychological impairment in older patients is possible, but less likely, and that epilepsy surgery in older patients should also be actively pursued. Lendt performed a behavioral assessment of 28 pediatric epilepsy patients and showed that the preoperative rate of behavioral abnormalities was 35.9% in the surgical group and 25% in the postoperative group, while the rate of behavioral abnormalities in the control group increased from 21.4% to 35.7% at baseline; this study strongly suggests that epilepsy surgery is significant in rapidly improving behavioral problems and preventing further behavioral impairment in pediatric epilepsy patients. Rausch et al. conducted a long-term follow-up of 44 patients with ATL and 8 medically treated adult TLE. 1 year postoperatively, patients with left-sided ATL showed a decline in VM, but a long-term examination revealed that both bilateral ATL may show a decline in VM, while other cognitive functions were not impaired. The authors’ (memory quotient, MQ) statistics of 58 adult ATL patients showed that the mean MQ values were higher after surgery than before surgery, with 27.6% MQ improvement and 19.0% decrease. 2. Factors affecting the level of cognition after temporal lobe surgery in epileptic hands Many reports suggest that cognitive impairment after TLE is mainly seen in the dominant hemisphere surgery. A group of MRI-negative TLE patients who underwent ATL surgery showed more postoperative impairment in VM function in patients with left-sided surgery. baxendale reported that verbal learning impairment may occur after 1/3 of ALTs, with left temporal lobectomy occurring twice as often as right, while 21% of right-sided ALTs versus 10% of left-sided ALTs showed improved learning function after surgery. SF tends to be a major influence on postoperative improvement in cognition and QOL, etc. Sabaz et al. reported changes in QOL after surgery in 35 children with epilepsy and showed that the total QOL score and each individual score of QOL were significantly higher in patients with SF than before surgery, whereas there was no significant change in QOL after surgery in patients who did not achieve SF. In addition, Maton et al. reported that in 20 patients who underwent ALT at around 3 years of age, postoperative families of SF felt that the patients’ motor function, cognitive and behavioral problems improved, along with an increase in QOL. However, this was not supported by Helmstaedter et al. who concluded that epilepsy control had a significant effect on postoperative cognitive changes and found a decrease in MQ after left-sided LTL regardless of whether SF,was achieved. Age is another factor affecting postoperative cognition.Gleissner reported 30 cases of experience with surgical treatment of temporal lobe epilepsy in children.Postoperative VM impairment was present in both children and adults with dominant lateral ATLE, only to a lesser extent than in adult patients, while VM impairment was similarly exacerbated after left-sided ALT in children, but recovered in all 1 year postoperatively, but was difficult to recover in adults. Preoperative MQ and QOL also affect postoperative QOL changes. The higher the preoperative VM score, the more pronounced the decrease after ATL. And low preoperative QOL scores improve postoperative QOL significantly, but the preoperative cognitive level of the elderly is significantly lower than that of the younger age group, and the postoperative decline is more pronounced, while the improvement rate is smaller, so this idea does not apply to the elderly. The surgical approach is also a factor affecting postoperative awareness. It has been suggested that selective temporal lobectomy has less cognitive impairment than standard anterior temporal lobectomy. by comparing trans-lateral fissure and transcortical selective hippocampal-amygdala resection for postoperative cognitive changes in TLE, Lutz found that the surgical modality did not affect cognitive changes, while VM decreased significantly when hippocampal sclerosis was not evident in dominant lateral ATL. Duchowny treated young children up to 3 years of age with resective surgery, and 70% of children with focal cortical dysplasia (FCD)-induced epilepsy achieved SF after surgery, but all patients showed significant improvement in developmental scores, concentration, increased vocabulary, and greater verbal fluency. Helmstaedter compared postoperative cognitive function in 33 patients with frontal lobe epilepsy with 45 patients with temporal lobe epilepsy and found a slight decrease in executive function after surgery for frontal lobe epilepsy (while temporal lobe epilepsy showed an increase), and a significant improvement in short-term memory in patients with postoperative SF. Hemispherectomy (HST) is second only to temporal and frontal lobectomy in pediatric epilepsy surgery.Arzimanoglou et al [17] reported 20 patients with Sturge-Weber syndrome who underwent surgical treatment, including lobectomy and HST, with no cognitive or motor impairment in any of the patients after surgery. Four adult patients were able to work, younger children without preoperative mental retardation were able to attend school normally, and two patients with mildly low IQ before surgery had improved IQ after surgery.Devlin et al [18] reported 33 patients with HST surgery with no exacerbated cases of cognitive impairment, but only 15% improved; 33% of patients showed improvement in behavioral problems after surgery and 15% worsened; 23% showed hemiparesis after surgery improvement and 27% exacerbation, while exacerbation of hemiparesis was also seen mainly in patients with Rasmussen’s encephalitis, probably related to further brain damage produced by encephalitis. II. Changes in QOL and NPA after palliative surgery CCT is currently used mainly for the surgical treatment of multifocal or generalized epilepsy with the aim of reducing drop seizures and generalized tonic-clonic seizures. After CCT for primary generalized epilepsy, 33% showed an increase in total intelligence quotient (IQ) (50% increase in operational IQ), 17% showed a decrease in IQ, and 50% increase in MQ, but no impaired cases. Another report showed a 62% improvement in activities of daily living after CCT, including a 93% reduction in hypermobility, a 42% improvement in emotion, and a 17-21% improvement in language function and memory, while 27% of adults and 6% of children showed a decrease in activities of daily living after surgery, with children showing a significantly lower rate than adults, probably related to the plasticity of the pediatric brain and less neurological impairment. The authors also treated 60 epileptic patients with CCT, 40 of whom were combined with low IQ, and the results suggested that there was a significant increase in QOL and PIQ in patients with low IQ after surgery, which may be due to the fact that CCT blocks the interhemispheric conduction of abnormal electrical activity, and after blocking abnormal discharge, excitatory behaviors or emotions caused by neuronal hyperexcitability (including irritability, hyperactivity, attention deficit, hallucinations, After blocking the abnormal firing, the excitatory behavior or emotions caused by neuronal hyperexcitability (including irritability, hyperactivity, attention deficit, hallucinations, mania, etc.) will be suppressed, while the normal electrical conduction of the suppressed neurons will be restored, resulting in the improvement of action and behavior disorders associated with MR patients. The improvement of postoperative QOL in epilepsy patients by CCT is basically positive. Vagus nerve stimulation (VNS). VNS is now also widely used for the palliative treatment of partial or generalized epilepsy with difficult to identify epileptic foci, multifocal epilepsy with extensive epileptic foci. Patients with combined low IQ showed significant improvements in overall QOL, attention span, word use, speech intelligibility, balance, and housekeeping skills at 1- and 2-year follow-up after VNS, as well as improvements in all other subscales at 1- or 2-year follow-up. The QOL records of patients with a history of craniotomy at 3 months postoperatively were significantly lower than those of the group without a history of surgery, with an improvement of 17% to 68% in each subscale, while the QOL registry at 2 years postoperatively showed a similar improvement in both groups, with an improvement of approximately 24% to 60% in each subscale. Third, the effect of radiation therapy on QOL in epilepsy patients Radiation therapy is mainly used in patients with temporal lobe epilepsy who refuse craniotomy or who require CCT, and radiation therapy to the medial temporal lobe or corpus callosum is performed surgically at doses ranging from 10 to 150 Gy. McDonald et al. reported a decrease in VM at long time 1-2 years after Gamma knife treatment in 3 cases of left-sided TLE. However, in a prospective European multicenter study, no neuropsychological impairment was found during the 24-month follow-up period in 21 patients with G-knife treated temporal lobe epilepsy, and there was significant improvement in duties and mental health in QOL compared to preoperative ones. The authors conducted a long-term follow-up of 7 patients with temporal lobe epilepsy treated with X-knife for 4-6 years and found impairment in IQ and MQ in 2 cases. Although the literature reports variable results and differing opinions on the effects of epilepsy surgery on cognition and QOL, in general, childhood epilepsy, postoperative SF patients, epilepsy with comorbid low IQ or dysfunction, and right temporal lobe epilepsy often have beneficial effects on QOL, and VNS and CCT, as palliative procedures, also tend to improve quality of life. However, in the elderly, especially in left temporal lobe epilepsy without significant hippocampal sclerosis, significant cognitive impairment is likely to occur after surgery, and quality of life is reduced, and surgery needs to be done with caution. Therefore, for surgically curable epilepsy, surgical treatment should not be the last option for treatment, and waiting too long will increase the chance of irreversible neuropsychological damage and decrease the rate of postoperative SF. , and significant improvements in QOL in terms of duty and mental health compared to preoperative ones. The authors followed seven patients with temporal lobe epilepsy treated with X-blade for 4-6 years over time and found impairment in IQ and MQ in two cases.