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Neuropsychological Evaluation of the Epilepsy Surgical Candidate

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Handbook on the Neuropsychology of Epilepsy

Part of the book series: Clinical Handbooks in Neuropsychology ((CHNEURO))

Abstract

Neurosurgical intervention is the primary treatment option for patients with partial epilepsies that are refractory to treatment with antiepileptic drugs (AEDs). The probability that a patient with epilepsy will be successfully treated with an AED greatly diminishes after two drug trial failures (Kwan & Brodie, 2000), and such patients are typically considered for surgical intervention (Kwan et al., 2010). Neuropsychological assessment is an integral component of the surgical management of patients with epilepsy, representing a useful clinical method for identifying optimal surgical candidates and maximizing outcome parameters while serving as a primary research tool. The practice of neuropsychology in the setting of the epilepsy monitoring unit has greatly enriched our understanding of neurocognitive processes and their underlying neural substrates, as this environment provides a unique opportunity to study brain functions in a highly controlled fashion before and after surgical resection. Likewise, the clinical impact of neuropsychology has been profound, as it represents a means to confirm seizure onset, to predict the possible effects of surgical intervention, and to track changes over time. Neuropsychologists are also ideally equipped to explain the potential risks and benefits of surgery to patients, to identify and address comorbid psychiatric issues, and to direct the course of cognitive rehabilitation when necessary following surgery. The goals of the current chapter include elucidating the purpose of neuropsychology in epilepsy surgery, exploring potential difficulties involved in obtaining a valid assessment of the epilepsy patient (e.g., dealing with the possible effects of acute seizure activity or the confounding effects of AEDs), and providing concrete recommendations regarding the selection of tests to achieve both clinical and research goals. A summary of the findings that have been amassed over the years regarding the presurgical confirmation of the seizure focus and postsurgical identification of neurocognitive deficits resulting from surgery is provided. In this context, research regarding the usefulness of neuropsychological results to predict surgical outcome is covered as well, and a clinical vignette is included to highlight several of the central topics.

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Authors and Affiliations

  1. Departments of Neurology and Pediatrics and Emory, The Emory University School of Medicine, Woodruff Memorial Research Building, 101 Woodruff Circle, Suite 6111, Atlanta, GA, 30322, USA

    Daniel L. Drane Ph.D., A.B.P.P. (C.N.)

  2. Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA

    Daniel L. Drane Ph.D., A.B.P.P. (C.N.)

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  1. Daniel L. Drane Ph.D., A.B.P.P. (C.N.)
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Correspondence to Daniel L. Drane Ph.D., A.B.P.P. (C.N.) .

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  1. Dept. Neurosurgery, New York University School of Medicine, New York, New York, USA

    William B. Barr

  2. Dept. Neurosurgery, New York University School of Medicine, New York, New York, USA

    Chris Morrison

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Drane, D.L. (2015). Neuropsychological Evaluation of the Epilepsy Surgical Candidate. In: Barr, W., Morrison, C. (eds) Handbook on the Neuropsychology of Epilepsy. Clinical Handbooks in Neuropsychology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92826-5_4

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