The neuropsychological evaluation is an important part of the workup when you have epilepsy. The results of the evaluation can be used to assist with epilepsy treatment planning by providing targeted recommendations aimed at maximizing strengths and minimizing weaknesses. The results of the neuropsychological evaluation can also be used to help identify the areas of the brain that have been impacted by seizure activity which can help identify the location of the seizure onset. This can be particularly helpful when you are being considered for epilepsy surgery.
In addition to assisting in localizing seizure onset, predictions can often be made regarding whether or not you might be at risk for postsurgical cognitive declines. When such risks are increased, this is communicated to you, so that you can make informed decisions regarding how to proceed. When seizures are found to be coming from areas in the brain that are also involved in language, additional tests are often required, including the Wada test (which evaluates whether a patient is a good candidate for surgery) and language mapping. These must be conducted and interpreted by a neuropsychologist who has specialized training in these procedures.
The term “cognition” refers to mental processes (including attention, processing speed, memory, language skills, perception, reasoning, judgment) that help a person function in everyday life. Cognitive problems are commonly seen in patients with epilepsy. Memory tends to be the area most often impacted, but other complaints include reduced ability to pay attention and focus, “mental slowing” and problems finding the right words for things. While these problems can be the direct result of seizure activity on brain functioning, there are additional factors that can impact thinking skills which are indirectly related to the diagnosis of epilepsy.
For example, while not all antiepileptic medications have cognitive side effects, there are a few that are known to cause problems with memory, attention, and processing speed in some patients. Additionally, depression and anxiety are seen in higher rates among epilepsy patients, and both of these disorders are known to have neuropsychological consequences. Finally, when seizures begin at an early age, this can impact cognitive development in a number of ways, including:
- Direct impact of seizure activity on neural development
- Indirect consequences associated with missed school days, reduced self-esteem, and limitations on activities
- Attention-deficit/ hyperactivity disorder (ADHD) in higher rates in children with epilepsy than in the general population
Patients with epilepsy experience depression and anxiety at higher rates than are seen in the general population. While these disorders can arise due to the impact of having a chronic medical problem, we now know that there is something specific to epilepsy that makes these individuals particularly vulnerable to experiencing emotional disturbance, possibly due to the specific areas of the brain that are involved. Specifically, the brain areas that are most often involved in seizure activity overlap with “emotional networks” of the brain.
The presence of depression and/or anxiety can significantly complicate the clinical picture, as we know that these disorders can further impact cognitive functions (above and beyond the effects of seizures on overall thinking abilities). Depression and/or anxiety tend to be strongly associated with overall quality of life in patients with epilepsy. Psychological functioning is routinely evaluated in the context of the neuropsychological evaluation, and appropriate recommendations are communicated to the treatment team based on the findings.
What Does a Neuropsychological Evaluation Involve?
A neuropsychological evaluation can take anywhere from two to 20 hours, depending on the patient and the nature of the question being answered. Most evaluations are between four and eight hours, although pediatric evaluations typically take longer. A comprehensive evaluation begins with a clinical interview with the patient and any other family members and/or significant others who might be able to provide information about the patient’s history.
The interview is followed by a formal examination that involves paper-and-pencil tests, hands-on activities, answering questions and, sometimes, using a computer. Questionnaires regarding social and emotional functioning are also completed by the patient and, when appropriate, significant others. In the case of pediatric patients, parents will be asked to fill out questionnaires about their child’s development and behavior. If the patient wears glasses or a hearing aid or any other device, s/he should make sure to bring it for the evaluation. If there are any special language needs, please alert the neuropsychologist to these prior to the appointment. Once the tests are completed, the neuropsychologist will score the data and write a report that summarizes the findings and impressions.
Neuropsychological Testing and Evaluation
Tests are administered to understand how well a person is functioning from both a cognitive and psychological standpoint. The evaluation can be used in a variety of ways, such as:
- Assessing an individual’s overall level of functioning
- Identifying relative strengths and weakness
- Uncovering cognitive impairments that can provide important information about the areas of the brain that may be affected
- Helping guide rehabilitation
- Clearly documenting and tracking changes in function over time
Test results are interpreted by a trained neuropsychologist.