Journal of Neurology and Neuropsychiatry

The preoperative evaluation of the function of vital organs including heart, lungs, liver and kidney is established practice across all surgical specialities. Effective perioperative evaluation and optimization has been shown to reduce postoperative medical complications, but nowadays there is a gap in the perioperative evaluation of neurological status [1]. Brain health is largerly overlooked by current modalities of perioperative assessment. On the other hand, existing protocols and guidelines focusing on modifiable risk factors for cardiac, pulmonary, renal, and metabolic-related complications have clearly demonstrated that prehabilitation strategies can decrease not only complication rates, but also 30-day mortality and length of hospital stay [2]. Frailty in the elderly population is strongly associated with the risk of postoperative complications, delirium, institutionalization, and mortality. Delirium remains the most common postoperative adverse event, with a pooled risk ratio of 2.13 (95% CI 1.23-3.67), but it can also be a marker of preclinical dementia and may contribute to delayed neurocognitive recovery [3]. It is indeed time to appreciate that surgical stress and systemic inflammation may lead to neuroinflammation, worsen preoperative neurologic status, and increase neurological complication rates in vulnerable individuals who lack physiological reserve and present with multisystemic functional deterioration. Use of Electroencephalography (EEG) monitoring as a guide to anesthetic titration to reduce the rate of perioperative cognitive disorders may prove a useful adjunct in this category of patients, but it is currently under investigation [4]. EEG is essential for differentiating delirium (a state of usually reversible global brain disfunction) and seizure disorders (a condition of spontaneous, recurrent paroxysmal electrical dysfunction), enabling the distinctly different treatment: Antiepileptic Drugs (AEDs) are a class of medications that have indeed received considerable attention as possible treatments for agitation and aggression, despite a lack of high-quality data and despite neurologist and psychiatrist often disagree on terminology.