Abstracts

Rationale: Despite the importance of psychosocial and cognitive issues among people with epilepsy (PWE), cognitive rehabilitation remains understudied as a service supplementing medical and surgical treatment in this population. We aimed to map the indications and use of cognitive rehabilitation in epilepsy (CoRE) across different countries worldwide.

Methods: Between July 2023 and March 2024, we conducted a web-based survey of epilepsy specialists practicing in different countries worldwide. Participants were asked to indicate patient groups referred for cognitive evaluation, the availability and accessibility of CoRE in their country of practice as well as the methodology applied during CoRE.

Results: One hundred and ten responses were received across 66 different countries: 45 respondents were from Europe, 35 – from Latin America, 14 – from the Eastern Mediterranean region, 7 – from Asia and Oceania, 8 – from Africa and 1 – from North America (as per the regional classification of the International League Against Epilepsy). Most participants were neurologists and/or epileptologists (96, 87%) practicing in university hospitals (69, 63%) and caring for adult patients (85, 77%). Major indications of referral for cognitive evaluation were cognitive complaints (88, 80%), perioperative examination (70, 64%) and intellectual disability (68, 62%). CoRE was reported as generally available in their country by 40 (36%) respondents (from 0/8 (0%) in Africa to 21/45 (46.7%) in Europe and 1/1 (100%) in North America), with an average accessibility of 5.4 ±2.5 out of 10. When available, CoRE is primarily used in patients with cognitive complaints (38, 81%), mood complaints or comorbid psychiatric disorders (27, 57%), intellectual disability (21, 45%), and candidates for epilepsy surgery (21, 45%). By methodology, individual sessions predominate (29, 62%) while group sessions are applied in 11 (23%) centers. CoRE programs are heterogeneous in form – compensatory (10, 21%), restitution (12, 26%) techniques, internal (12, 26%), and external (12, 26%) strategies are used alongside psychoeducation (15, 32%) and psychological counseling (16, 34%) without clear predominance of either approach. In 13 (32.5%) cases, CoRE was indicated to be supported by national standards of practice or state legislature.

Conclusions: Cognitive rehabilitation programs for PWE are underused and lack accessibility across epilepsy centers across the world, especially in the context of perioperative care. New evidence-based procedure development and harmonization is required to promote establishment and effective use of these services.

Funding: None.