Current standards of neuropsychological assessment in epilepsy surgery centers across Europe

Abstract

We explored the current practice with respect to the neuropsychological assessment of surgical epilepsy patients in European epilepsy centers, with the aim of harmonizing and establishing common standards. Twenty-six epilepsy centers and members of "E-PILEPSY" (a European pilot network of reference centers in refractory epilepsy and epilepsy surgery), were asked to report the status of neuropsychological assessment in adults and children via two different surveys. There was a consensus among these centers regarding the role of neuropsychology in the presurgical workup. Strong agreement was found on indications (localization, epileptic dysfunctions, adverse drugs effects, and postoperative monitoring) and the domains to be evaluated (memory, attention, executive functions, language, visuospatial skills, intelligence, depression, anxiety, and quality of life). Although 186 different tests are in use throughout these European centers, a core group of tests reflecting a moderate level of agreement could be discerned. Variability exists with regard to indications, protocols, and paradigms for the assessment of hemispheric language dominance. For the tests in use, little published evidence of clinical validity in epilepsy was provided. Participants in the survey reported a need for improvement concerning the validity of the tests, tools for the assessment of everyday functioning and accelerated forgetting, national norms, and test co-normalization. Based on the present survey, we documented a consensus regarding the indications and principles of neuropsychological testing. Despite the variety of tests in use, the survey indicated that there may be a core set of tests chosen based on experience, as well as on published evidence. By combining these findings with the results of an ongoing systematic literature review, we aim for a battery that can be recommended for the use across epilepsy surgical centers in Europe.

Getting the best outcomes from epilepsy surgery

“…Surgical reference centers are currently attempting to standardize assessments and provide evidence-based recommendations for test selection. 94 It is essential to consider the adverse cognitive effects of medication 93 and recent seizures. Furthermore, psychiatric comorbidities may adversely affect test performance, 95 and these should be assessed by screening measures.…”

Postoperative seizure freedom does not normalize altered connectivity in temporal lobe epilepsy

“…First, while neuropsychological batteries for epilepsy surgery planning share key features across institutions, there is a relative lack of standardizations in terms of which tests are performed, even within institution, in part motivated by a need to tailoring testing to the individual patient being assessed 30 . Furthermore, neuropsychological testing done for the purpose of epilepsy presurgical planning often utilizes tests of cognitive function that are not well matched to the type of tests used to delineate cognitive functional networks in the neuroimaging literature 31 , i.e.…”

“…First, although neuropsychological batteries for epilepsy surgery planning share key features across institutions, there is a relative lack of standardization in terms of which tests are performed, even within an institution, in part motivated by a need to tailor testing to the individual patient being assessed. 30 Furthermore, neuropsychological testing done for the purpose of epilepsy presurgical planning often utilizes tests of cognitive function that are not well matched to the type of tests used to delineate cognitive functional networks in the neuroimaging literature, 31 that is, routine clinical neuropsychological tests would not necessarily track the functional networks explored in this study. Therefore, as a rule, future studies pairing cognitive tests well matched to the functional networks explored may be able to capture more nuanced changes resulting from epilepsy surgery, and specifically tie a neuroimaging correlate to a cognitive change.…”

Predicting verbal memory decline following temporal lobe resection for epilepsy

“…All neuropsychological methods (outcome variable and potential predicting variables) were part of a comprehensive standard assessment for epilepsy surgery meeting the current standards of neuropsychological assessment in epilepsy surgery centres across Europe . The same memory variables (in parallel versions, to minimize practice effects) were used during the whole study period (1987‐2013).…”