Abstracts

Rationale: Neuropsychological assessment of patients with epilepsy is a distinctive subspecialty in clinical neuropsychology; its goals and methodological approaches differ from those in other subspecialties. Besides providing information about the functional effects of the epileptogenic lesion (lateralisation and localisation), this evaluation also provides detailed characterization of cognitive strengths and weaknesses, prediction and monitoring of the course and outcome, and allows counselling regarding quality of life issues. However, the field is characterized by a diversity of approaches. We aimed to investigate and portray current practices of neuropsychologists in this field, including demographic (gender, level of training, years of practice), clinical (duration and number of test sessions, number of administered tests, time spent testing patients), and testing variables (choices of tests within a number of domains, satisfaction, source of norms). We also aimed to compare the results of the current survey with those of a previous one (Jones-Gotman M, Smith ML, and Zatorre, RJ, 1993. Neuropsychological testing for lateralizing and localizing the epileptogenic region. In J. Engel (Ed.), Surgical Treatment of the Epilepsies, New York: Raven Press, 245-261). Methods: We constructed a questionnaire, divided into four sections: demographics, clinical practice, test choices and satisfaction, and feedback; in the latter, respondents were invited to comment on current methods and indicate areas that need improvement. We listed 163 tests and provided room to add tests we had not listed. We conducted a search to identify epilepsy centers throughout the world, aiming to include all neuropsychologists working in this specialty. We identified 185 epilepsy centers in 22 countries, and to date have sent the questionnaire to 112 colleagues. Here we report results from the first 30 responses. Results: Neuropsychologists who evaluate patients with epilepsy typically spend 5.5 hours (range 2.5-12) assessing these patients; 30% of these assessments are completed in one testing session, 46.7% in two, and 23.3% in three or more sessions. The mean number of tests that constitute a standard test battery is 28 (range 12-54), and on average 21 others (range 0-58) are used as optional measures when needed. Several tests, e.g. Wechsler IQ and memory, as well as the Boston Naming Test, continue to be the most frequently used tools. Some new tests are now also seeing wide use and some others are used less frequently than in 1993. Very few clinicians simply use whole batteries but rather they select tests from within them. Conclusions: Our results to date indicate an evolution over time in neuropsychological practice in epilepsy settings. The evaluation continues to be comprehensive, but there is a movement towards shortening the average time spent in assessment. The use of certain tests continues to be widespread, as was the case 16 years ago, but there is increased use of more specialized tests. The results reflect some increase in diversity growing out of new developments in the study of brain and behavior.