Adult Epilepsy

  • Erica M. Brandling-Bennett
  • David G. Vossler


Epilepsy is one of the most common neurological diseases, which can arise from a variety of etiologies. Given the heterogeneity of the disease, patients with epilepsy can have vastly different levels of intellectual and neurocognitive functioning. Neuropsychological evaluations can be used in patients with a variety of epilepsy syndromes in order to assess their neurocognitive strengths and weaknesses so as to aid in understanding their level of functioning and in informing, planning, and evaluating various interventions and treatment plans. This chapter briefly outlines how comprehensive neuropsychological evaluations are generally used in assessing patients with epilepsy. The main focus of the chapter provides a more comprehensive review of how neuropsychological evaluations are used in the pre- and postsurgical management of patients with epilepsy, most commonly patients with medically intractable mesial temporal lobe epilepsy.


Epilepsy Seizures Medically intractable seizures Mesial temporal lobe epilepsy Presurgical neuropsychological evaluations Wada test 


  1. 1.
    England MJ, Liverman CT, Schultz AM, Strawbridge LM, editors. Epilepsy across the spectrum: promoting health and understanding. Washington, DC: The National Academics Press; 2012.Google Scholar
  2. 2.
    Engel J Jr, Pedley TA. Introduction: what is epilepsy? In: Engel J, Pedley T, editors. Epilepsy: a comprehensive textbook. Philadelphia, PA: Lippincott, Williams, & Wilkins; 2008. p. 1–7.Google Scholar
  3. 3.
    Hauser, WA, Annegers, JF, and Kurland, LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia. 1993; 34(3): 453–468.PubMedCrossRefGoogle Scholar
  4. 4.
    Akanuma N, Alarcon G, Lum F, Kissani N, Koutroumanidis M, Adachi N, Binnie CD, Poley CE, Morris RG. Lateralising value of neuropsychological protocols for presurgical assessment of temporal lobe epilepsy. Epilepsia. 2003;44(3):408–18.PubMedCrossRefGoogle Scholar
  5. 5.
    Swanson SJ. Neuropsychological testing is of limited value for predicting the epileptogenic zone. In: Silbergeld JMD, editor. Controversies in epilepsy surgery. New York, NY: Marcel Dekker Inc.; 2006. p. 214–20.Google Scholar
  6. 6.
    National Association of Epilepsy Centers (NAEC). Guidelines for essential services, personnel, and facilities in specialized epilepsy centers. Minneapolis, MN: NAEC; 2010.Google Scholar
  7. 7.
    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.CrossRefGoogle Scholar
  8. 8.
    Scott AJ, Sharpe L, Hunt C, Gandy M. Anxiety and depressive disorders in people with epilepsy: a meta-analysis. Epilepsia. 2017;58(6):973–82.PubMedCrossRefGoogle Scholar
  9. 9.
    Kobau R, Gilliam F, Thurman DJ. Prevalence of self-reported epilepsy or seizure disorder and its associations with self-reported depression and anxiety: results from the 2004 HealthStyles Survey. Epilepsia. 2006;47(11):1915–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Wittchen HU, Kessler RC, Beesdo K, Krause P, Hofler M, Hoyer J. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry. 2002;63(Suppl 8):24–34.PubMedGoogle Scholar
  11. 11.
    Hesdorffer DC, Hauser WA, Olafsson E, Ludvigsson P, Kjartansson O. Depression and suicide attempt as risk factors for incident unprovoked seizures. Ann Neurol. 2006;59(1):35–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Loring DW, Strauss E, Hermann BP, Barr WB, Perrine K, Trenerry MR, Chelune G, Westerveld M, Lee GP, Meador KJ, Bowden SC. Differential neuropsychological test sensitivity to left temporal lobe epilepsy. J Int Neuropsychol Soc. 2008;14:394–400.PubMedCrossRefGoogle Scholar
  13. 13.
    Helmstaedter C, Elger CE. Chronic temporal lobe epilepsy: a neurodevelopmental or progressively dementing disease? Brain. 2009;132. (Pt. 10:2822–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Brunbech L, Sabers A. Effect of antiepileptic drugs on cognitive function in individuals with epilepsy: a comparative review of newer versus older agents. Drugs. 2002;62(4):593–604.PubMedCrossRefGoogle Scholar
  15. 15.
    Sommer BR, Mitchell EL, Wroolie TE. Topiramate: effects on cognition in patients with epilepsy, migraine headache and obesity. Ther Adv Neurol Disord. 2013;6(4):211–27.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Helmstaedter C, Kurthen M, Lux S, Reuber M, Elger CE. Chronic epilepsy and cognition: a longitudinal study in temporal lobe epilepsy. Ann Neurol. 2003;54(4):425–32.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Hermann BP, Seidenberg M, Dow C, Jones J, Rutecki P, Bhattacharya A, Bell B. Cognitive prognosis in chronic temporal lobe epilepsy. Ann Neurol. 2006;60(1):80–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Seidenberg M, Pulsipher DT, Hermann B. Cognitive progression in epilepsy. Neuropsychol Rev. 2007;17(4):445–54.PubMedCrossRefGoogle Scholar
  19. 19.
    Crawford PM. Epidemiology of intractable focal epilepsy. In: Oxbury JM, Polkey CE, Duchowny M, editors. Intractable focal epilepsy. London: WB Saunders; 2000. p. 25–40.Google Scholar
  20. 20.
    Hauser WA, Annegers JF, Kurland LT. The prevalence of epilepsy in Rochester, Minnesota: 1940–1980. Epilepsia. 1991;32(4):429–45.PubMedCrossRefGoogle Scholar
  21. 21.
    Panayiotopoulos CP. A clinical guide to epileptic syndromes and their treatment. Oxfordshire: Bladon Medical Publishing; 2002.Google Scholar
  22. 22.
    Vossler DG, Rostad SW, Haltiner AM, Davis B, Powell TW, Bell AJ, Kraemer DL. Increased ictal discharge frequency and neocortex gliosis in lateral temporal lobe epilepsy. J Clin Neurophysiol. 2012;29(5):449–57.PubMedCrossRefGoogle Scholar
  23. 23.
    Wiebe S. Epidemiology of temporal lobe epilepsy. Can J Neurol Sci. 2000;27(Suppl 1):S6–S10.PubMedCrossRefGoogle Scholar
  24. 24.
    Sauerwein HC, Gallagher A, Lassonde M. Neuropsychological deficits in children with temporal lobe epilepsy. In: Arzimanoglou A, Aldenkamp A, Cross H, Lassonde M, Moshé S, Schmitz B, editors. Cognitive dysfunction in children with temporal lobe epilepsy. Paris: John Libbey Eurotext; 2005. p. 1–12.Google Scholar
  25. 25.
    Lee TM, Yip JT, Jones-Gotman M. Memory deficits after resection from left or right anterior temporal lobe in humans: a meta-analytic review. Epilepsia. 2002;43(3):283–91.PubMedCrossRefGoogle Scholar
  26. 26.
    Jokeit H, Ebner A. Effects of chronic epilepsy on intellectual functions. Prog Brain Res. 2002;135:455–63.PubMedCrossRefGoogle Scholar
  27. 27.
    Engel J Jr. Etiology as a risk factor for medically refractory epilepsy: a case for early surgical intervention. Neurology. 1998;51(5):1243–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Engel J Jr, McDermott M, Wiebe S, Langfitt J, Stern J, Dewar S, Sperling M, Gardiner I, Erba G, Fried I, Jacobs M, Vinters H, Mintzer S, Kieburtz K, the ERSET Study Group. Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA. 2012;307(9):922–30.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Loring DW, Lee GP, Martin RC, Meador KJ. Material-specific learning in patients with partial complex seizures of temporal lobe origin: convergent validation of memory constructs. J Epilepsy. 1988;1:53–9.CrossRefGoogle Scholar
  30. 30.
    McDonald CR, Bauer RM, Grande L, Gilmore R, Roper S. The role of the frontal lobes in memory: evidence from unilateral frontal resections for relief of intractable epilepsy. Arch Clin Neuropsychol. 2001;16:571–85.PubMedCrossRefGoogle Scholar
  31. 31.
    Jones-Gotman M, Zatorre RJ, Olivier A, Andermann F, Cendes F, Staunton H. Learning and retention of words and designs following excision from medial or lateral temporal-lobe structures. Neuropsychologia. 1997;35:963–73.PubMedCrossRefGoogle Scholar
  32. 32.
    Barr WB, Chelune GJ, Hermann BP, Loring DW, Perrine K, Strauss E, Trenerry MR, Westerveld M. The use of figural reproduction tests as measures of nonverbal memory in epilepsy surgery candidates. J Int Neuropsychol Soc. 1997;3(5):435–43.PubMedGoogle Scholar
  33. 33.
    Pigott S, Milner B. Memory for different aspects of complex visual scenes after unilateral temporal- or frontal-lobe resection. Neuropsychologica. 1993;31:1–15.CrossRefGoogle Scholar
  34. 34.
    Holmes MD, Miles AN, Dodrill CB, Ojemann GA, Wilensky AJ. Identifying potential surgical candidates in patients with evidence of bitemporal epilepsy. Epilepsia. 2003;44:1075–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Chelune GJ. Hippocampal adequacy versus functional reserve: predicting memory functions following temporal lobectomy. Arch Clin Neuropsychol. 1995;10:413–32.PubMedCrossRefGoogle Scholar
  36. 36.
    Wada J. A new method for the determination of the side of cerebral speech dominance. A preliminary report of the intra-carotid injection of sodium amytal in man. Igaku Seibutsugaki. 1949;14:221–2.Google Scholar
  37. 37.
    Loring DW, Meador KJ, Lee GP, King DW. Amobarbital effects and lateralized brain function: the Wada test. New York: Springer-Verlag; 1992.CrossRefGoogle Scholar
  38. 38.
    Milner B, Branch C, Rasmussen T. Study of short-term memory after intracarotid injection of sodium amytal. Trans Am Neurol Assoc. 1962;87:224–6.Google Scholar
  39. 39.
    Bookheimer S. Pre-surgical language mapping with functional magnetic resonance imaging. Neuropsychol Rev. 2007;17(2):145–55.PubMedCrossRefGoogle Scholar
  40. 40.
    Janecek JK, Swanson SJ, Sabsevitz DS, Hammeke TA, Raghavan M, E Rozman M, Binder JR. Language lateralization by fMRI and Wada testing in 229 patients with epilepsy: rates and predictors of discordance. Epilepsia. 2013;54(2):314–22.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Swanson SJ, Sabsevitz DS, Hammeke TA, Binder JR. Functional magnetic resonance imaging of language in epilepsy. Neuropsychol Rev. 2007;17(4):491–504.PubMedCrossRefGoogle Scholar
  42. 42.
    Binder JR, Swanson SJ, Sabsevitz DS, Hammeke TA, Raghavan M, Mueller M. A comparison of two fMRI methods for predicting verbal memory decline after left temporal lobectomy: language lateralization versus hippocampal activation asymmetry. Epilepsia. 2010;51(4):618–26.PubMedCrossRefGoogle Scholar
  43. 43.
    Vannest J, Szaflarksi JP, Privitera MD, Schefft BK, Holland SK. Medial temporal fMRI activation reflects memory lateralization and memory performance in patients with epilepsy. Epilepsy Behav. 2008;12(3):410–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Killgore WD, Glosser G, Casasanto DJ, French JA, Alsop DC, Detre JA. Functional MRI and the Wada test provide complementary information for predicting post-operative seizure control. Seizure. 1999;8(8):450–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Janecek JK, Swanson SJ, Sabsevitz DS, Hammeke TA, Raghavan M, Mueller W, Binder JR. Naming outcome prediction in patients with discordant Wada and fMRI language lateralization. Epilepsy Behav. 2013;27(2):399–403.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Sabsevitz DS, Swanson SJ, Hammeke TA, Spanaki MV, Possing ET, Morris GL 3rd, Mueller WM, Binder JR. Use of preoperative functional neuroimaging to predict language deficits from epilepsy surgery. Neurology. 2003;60(11):1788–92.PubMedCrossRefGoogle Scholar
  47. 47.
    Binder JR, Sabsevitz DS, Swanson SJ, Hammeke TA, Raghavan M, Mueller WM. Use of preoperative functional MRI to predict verbal memory decline after temporal lobe epilepsy surgery. Epilepsia. 2008;49(8):1377–94.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Labudda K, Mertens M, Aengenendt J, Ebner A, Woermann FG. Presurgical language fMRI activation correlates with postsurgical verbal memory decline in left-sided temporal lobe epilepsy. Epilepsy Res. 2010;92(2–3):258–61.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Erica M. Brandling-Bennett
    • 1
  • David G. Vossler
    • 1
  1. 1.UW Medicine—Valley Medical Center Neuroscience InstituteRentonUSA

Personalised recommendations