Neuropsychological Evaluation in Epilepsy

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Many people with epilepsy complete a neuropsychological evaluation as part of their epilepsy care.  This article is written by Doug Heck, Ph.D., and member of EFMN’s Professional Advisory Board, to help explain what this evaluation is, its role in epilepsy care and its benefit for people with epilepsy.

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Neuropsychological Evaluation in Epilepsy
by Professional Advisory Board member Doug Heck, Ph.D.

 

 

Many people with epilepsy complete a neuropsychological evaluation as part of their epilepsy care.  This article is written in order to help explain what this evaluation is, its role in epilepsy care, and its benefit for people with epilepsy.

Neuropsychological evaluation has long been an essential component in the diagnosis and treatment of multiple medical conditions, especially epilepsy.  It is important in the 1) diagnosis of medical and psychological conditions related to epilepsy, 2) development of a plan of care, 3) identification of specific interventions to address problematic areas, such as memory difficulties, or work performance problems, and 4) fostering of research studies to improve the lives of people with epilepsy and their families.  Neuropsychologists in epilepsy have completed specialized training in understanding the brain’s role in such areas as cognition, emotional functioning, and behavioral patterns, taking into account an individual’s seizures, epilepsy medication, medical history, development from childhood to adulthood, and mental health.  Their assessment includes a review of medical and possibly school records, an interview with the person with epilepsy and sometimes a family member, and completion of a number of standardized cognitive tests and psychological questionnaires.  This evaluation typically requires 2 to 4 hours of testing time, and may require more than one appointment to complete all components of the assessment process. The testing is often completed in a quiet room, with the patient answering questions, completing written tasks, and using one’s hands to construct and draw. Because this testing can be somewhat strenuous, it’s recommended that the patient get a good sleep the night before. After analysis of the information from this assessment, the neuropsychologist will then write a report and consult with the medical team, the person with epilepsy, and others as needed, such as teachers and family members.

Neuropsychological evaluation is especially useful in understanding the cognitive functioning of the person with epilepsy. Areas assessed commonly include intelligence, verbal and nonverbal memory, attention and concentration, speech and language, academic skills, visual-perceptual abilities, and sensory and manual motor skills.  In addition, one’s executive functioning is assessed, which includes reasoning, planning, problem solving, impulse control, and insight.  Occasionally, follow-up neuropsychological evaluations are completed, which can help determine changes in cognition over time.

Neuropsychological evaluation often includes assessment of emotional functioning and behavioral patterns which can be helpful in understanding the person with epilepsy’s daily functioning, or any particular difficulties they may be having at school, work, or in their relationships with others.  For example, if depression is present, it can result in not only the typical symptoms of sadness and withdrawal, but also can affect memory functioning, speed of information processing, and other areas of cognition.  If a child is experiencing behavioral outbursts and significant anger, neuropsychological evaluation can help determine whether this is related to seizures, medication, developmental delays, a behavioral disorder, poor coping, or underlying emotional difficulties.

Here are some common areas in which neuropsychological evaluation can be especially useful:

School Functioning: It’s not unusual for children and teenagers with epilepsy to have periodic problems at school, such as difficulties learning, remembering, or staying focused.  In addition, students may unfortunately experience stigma or other difficult experiences due to their epilepsy, resulting in anger, school refusal, social withdrawal, or decline in academic performance.  Parents often try to determine how best to help their children/teenagers in these situations, and seek assistance from teachers, school counselors, other parents, and the medical team.  Neuropsychological evaluations can be especially helpful in clarifying the student’s baseline cognitive and behavioral functioning, and help determine whether or not their problems at school are due to effects from seizures, underlying learning or memory impairment that may be long-standing,  temporary medication side effects, adjustment/coping difficulties, or other issues.  Specific and detailed recommendations are developed to help address the student’s difficulties, which may include such things as providing extra time to complete tests, using a quiet area to study, suggestions for specific curriculum changes, altering medication doses or possibly the timing of doses to help improve cognition, and suggestions for building their self-esteem and coping skills. The neuropsychologist may then consult with the school and medical team directly to help develop and implement a plan, such as an IEP (Individualized Education Plan) if needed, to help the student have a better school experience.

Vocational Planning: Juniors and seniors in high school, parents, and young adults with epilepsy often have many important decisions to make about how best to move ahead with their lives.  Questions may occur about whether the person with epilepsy has the capacity to emancipate and safely live independently, and if not, what type of assistance is needed. Students often try to decide whether or not they should move on to college, obtain vocational training, or pursue some other path after high school.  To make these decisions, it is important to not only understand one’s cognitive abilities, but also one’s level of maturity, capacity to manage stress, level of independence, and responsibility for self-care.  A neuropsychological evaluation can be especially useful at this time, as it can identify cognitive and personality patterns that can help with these decisions.  For example, if a student or young adult has particularly strong verbal memory and learning, but struggles with focusing and concentrating, then any vocational or college choices that are made should take this into consideration.  In this case, it might be advisable for the student to choose vocational training that will fit his/her strengths and not require lengthy concentration. Or if college is chosen, it would be important to set up adaptations to help improve concentration and ensure academic success. Colleges and vocational training programs have multiple resources available to help students with epilepsy have a successful experience. 

Epilepsy Care: Neuropsychological evaluations can assist in decisions about medication.  As medication doses are changed in order to try to bring about better seizure control, changes in cognition and behavior can sometimes occur.  Brief, repeated neuropsychological evaluations can be useful in detecting changes in alertness, speed of information processing, memory, and concentration, and then can guide decisions about whether or not a medication, or its dosage, should be changed.

Neuropsychological assessment is an important component of pre- and post-surgical epilepsy evaluations.  Neuropsychological test results are correlated with how well certain areas of the brain are performing.  For example, in most right-handed people, their left temporal lobe is responsible for producing verbal memory, while their right temporal lobe is more responsible for nonverbal memory.  If one has strong nonverbal memory, but struggles with verbal memory, then this is suggestive that their left temporal lobe function may be affected by their epilepsy, and possibly may be the location from which their seizures arise.  This information then is combined with available medical information to help determine one’s candidacy for epilepsy surgery.  Comparing one’s pre-and post-surgical neuropsychological evaluation results can help clarify what changes have occurred, if any, and how well someone may be adapting to their life after surgery.

Conclusion:  In summary, neuropsychological evaluations in epilepsy not only assist with epilepsy care such as medication decisions and determination of surgical candidacy, but also help with a number of very important life decisions that people with epilepsy have to make with respect to school, work, safety, and quality of life. If you are interested in obtaining a neuropsychological evaluation, ask your physician about whether it would be helpful in your situation.

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