Neuropsychological assessment

To assess cognitive and emotional functioning we can use a neuropsychological evaluation.

In this case the referral of questions is crucial, and it can be: Is the cognitive complaints related to the seizure focus? or, is the cognitive complaints related to

the brain pathology underlying the seizure disorder or is the cognitive 00:00:38.110 –> 00:00:43.030 complaints related to a psychosocial condition or to

adverse cognitive side effects associated with antiepileptic drugs? However, we have to consider that if the diffuse effect of seizures, functional reorganisation of the brain, sensitivity of cognitive tests to other comorbidity, can limit the value of neuropsychological testing in localising the seizure foci. For this reason we have to consider all together neuropsychological data, information on age at onset, language lateralisation, and data from structural images. Only the combination of all these information can accurately predict the prognosis of the disorder. Early onset of seizures has a negative effect on an array of cognitive functions beyond the seizure focus.

Neuropsychological assessment of patients with epilepsy should include a broad battery of tests in order to evaluate both focal and diffuse effects of localisation related or generalised seizure disorder. Effects of variables on poor cognition are Age at onset, Number and type of an epileptic drugs Duration of seizure disorders, Frequency of seizures, Presence of mesial temporal lobe sclerosis and reduced hippocampal volumes, which are associated with poorer memory performance. Attention and processing speed have to be evaluated because difficulties in this domain can affect interpretation in all other tests. Both are sensitive to effects of anti epileptic drugs. Comparison between visual and verbal tasks is necessary to evaluate differences across hemispheres.

Motor and sensory examination are essential to evaluate motor slowing and lateralizing motor and sensory effects of focal seizure disorder. We have to remember all side effects of antiepileptic drugs. These drugs work by reducing neural activity and can lead to undesirable cognitive and behavioural side effects. Thus the risk benefit ratio should be considered. Fewer cognitive side effects are seen with the newer generation of antiepileptic drugs.