Referral for neuropsychological assessment in epilepsy is important but neurologists need to understand the scope and limitations of such investigations. Here’s 10 tips gleaned from an expert, international team as published recently in the European Journal of Neurology.

1. A neuropsychological assessment is a collaborative investigation. The more information a neurologist can provide on symptoms, history and clinical findings, the better the neuropsychologist will be able to interpret the findings from their tests.
2. Neuropsychological assessment can assess the impact of medical and surgical treatment for epilepsy on cognitive function as well as on the underlying condition. A baseline assessment, prior to treatment, allows for more accurate assessment of treatment effects.
3. Cognitive difficulties and seizures are frequently different symptoms of a common underlying pathology. Both the site and nature of the lesion itself, and its neurodevelopmental context, play an important role in shaping the associated deficit.
4. Comorbidities such as depression, anxiety, dementia and migraine impact neuropsychological function and have to be differentiated from secondary effects of seizures and treatment. This reinforces the need for baseline assessments.
5. The correlation between patients’ subjective cognitive complaints and neuropsychological measures of cognitive function can be poor to modest. Patient complaints, e.g. about their memory, are often more related to mood and general psychological distress.
6. The results from a neuropsychological assessment can be used to maximise the educational potential of children with epilepsy through early identification and early intervention. Assessment reports can also help adults achieve occupational goals e.g. by guiding modifications to their workday or environment.
7. Not all patients are able to engage with the demands of a neuropsychological assessment. People with severe deficits in attention or language comprehension, high levels of mood disturbance or other emotional factors may not return valid results.
8. Language and cultural norms also influence performance in neuropsychological tests. There are significant limitations in the conclusions that can be drawn from assessments conducted in a second language with tests that have been standardised on different populations to that of the patient.
9. Practice effects can have a significant impact on neuropsychological test performance. Ensure an adequate interval between referrals for neuropsychological assessments in order to maximise the sensitivity of the assessment to change.
10. Neuropsychological assessment is not a treatment, much less a cure. When referring someone with epilepsy ensure that they are fully informed about the purpose of the neuropsychology assessment and have realistic expectations of the outcome.