Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, London, UK
Melbourne School of Psychological Sciences, The University of Melbourne and Comprehensive Epilepsy Program, Austin Health, Melbourne, Australia
University Department of Neurosciences, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
Departments of Neurology & Psychiatry, NYU School of Medicine, New York, USA
Department of Epileptology, University of Bonn, Bonn, Germany
Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
Departments of Neurology and Psychiatry, University of Rochester School of Medicine, Rochester, New York, USA
Medical Department, University of Heidelberg, Germany
Institute and Department of Psychiatry, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Brazil
Epilepsy Unit, la Pitié-Salpêtrière Hospital, Paris, France and Neuropsychology and Auditory Cognition, University of Lille, France
Department of Psychology, University of Toronto Mississauga and Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Canada
Correspondence: Sallie Baxendale
UCL, Queen Square, Institute of Neurology,
Chalfont St Peter,
London SL9 0RJ, UK
- Key words: neuropsychology, epilepsy surgery, adult, paediatric, assessment, outcome, guidelines, ILAE
- DOI : 10.1684/epd.2019.1065
- Page(s) : 221-34
- Published in: 2019
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License
In our first paper in this series (Epilepsia 2015; 56(5): 674-681), we published recommendations for the indications and expectations for neuropsychological assessment in routine epilepsy care. This partner paper provides a comprehensive overview of the more specialist role of neuropsychological assessment in the pre and postoperative evaluation of epilepsy surgery patients. The paper is in two parts. The first part presents the framework for the mandatory role of neuropsychologists in the presurgical evaluation of epilepsy surgery candidates. A preoperative neuropsychological assessment should be comprised of standardised measures of cognitive function in addition to wider measures of behavioural and psychosocial function.
The results from the presurgical assessment are used to: (1) establish a baseline against which change can be measured following surgery; (2) provide a collaborative contribution to seizure characterization, lateralization and localization; (3) provide evidence-based predictions of cognitive risk associated with the proposed surgery; and (4) provide the evidence base for comprehensive preoperative counselling, including exploration of patient expectations of surgical treatment.
The second part examines the critical role of the neuropsychologist in the evaluation of postoperative outcomes. Neuropsychological changes following surgery are dynamic and a comprehensive, long-term assessment of these changes following surgery should form an integral part of the postoperative follow-up. The special considerations with respect to pre and postoperative assessment when working with paediatric populations and those with an intellectual disability are also discussed.
The paper provides a summary checklist for neuropsychological involvement throughout the epilepsy surgery process, based on the recommendations discussed.