Paradigm Shifts in the Neuropsychology of Epilepsy

Introduction

Neuropsychology and Epilepsy: The study of epilepsy has significantly contributed to understanding brain function.
Clinical Role: Neuropsychology assesses epilepsy impact through factors like age of onset, seizure type, medications, etc.
Neuroimaging: Advances in neuroimaging have improved understanding of cognitive abnormalities and their neurobiological markers.
Review Focus: The review highlights significant developments in neuropsychology and epilepsy over the last 50 years.

Classification: Primary phenotyping uses international classifications, focusing on lobar sites of origin.
Temporal Lobe Epilepsy (TLE): Most common localization-related epilepsy with significant cognitive investigation.
Memory Systems: Declarative vs. procedural memory distinctions and material-specific models dominate.
Cognitive Impairments: Studies show that cognitive abnormalities extend beyond pathophysiological boundaries.
Generalized Cognitive Abnormality: Impacts memory, IQ, executive functions, language, and more.
Genetic Generalized Epilepsies (GGE): Attention and executive function are not the only affected domains.
Neuroimaging Studies: Documented distributed brain abnormalities and their cognitive consequences.
Paradigm Shift: Cognitive abnormalities are influenced by distributed neurobiological abnormalities, not just epilepsy location.

Comorbidity in Epilepsy: High prevalence of medical, psychiatric, and social disorders.
Bidirectional Relationships: Psychiatric comorbidities can appear before seizure onset, serving as risk factors.
Shared Susceptibilities: Evidence of cognitive and behavioral abnormalities in relatives of epilepsy patients.
Implications for Care: Early screening for comorbidities is crucial for timely intervention and treatment.

QoL Measures: Initially assessed via clinical interviews and broad cognitive tests.
Disease-Specific Measures: Development of tools like the Washington Psychosocial Seizure Inventory.
Formal HRQOL: Integration of health-related QoL measures into epilepsy care.
Epilepsy Surgery: Influential in developing HRQOL assessments and emphasizing seizure severity.

Historical Context: Surgery was a last-resort treatment; now it's considered earlier.
Cognitive Outcomes: Risk of memory decline post-surgery influenced by hippocampal integrity.
Surgical Techniques: Techniques like selective amygdalohippocampectomy aim to preserve cognitive function.
Semantic Memory Systems: Focal epilepsy's impact on naming abilities and semantic memory.
Plasticity: Language dominance and reorganization assessed via Wada test and fMRI.

Cognitive Effects of AEDs: Differential neuropsychological impacts used to guide medication selection.
Phenobarbital Studies: Showed long-term cognitive effects, influencing treatment practices.
Neuropsychological Testing: Increasingly used in clinical trials for overall treatment effectiveness.

Assessment Paradigms: Anticipated changes in neuropsychological evaluations and increased routine testing.
Interventions: Emphasis on intervention trials to improve life outcomes.
EEG and Spikes: Investigation of EEG abnormalities' impact on cognition.
New Measures and Classifications: Development of new cognitive assessments and classifications.
Neurodegenerative Proteins: Exploration of proteins like tau in epilepsy-related cognitive decline.
Modifiable Risk Factors: Focus on lifestyle factors influencing brain health and cognitive aging.