A - 113 Strengths-Based Neuropsychology in Neurological Surgery: a Neuropsychiatric Case Study of Treatment Refractory Right-Sided Focal Seizures.

Abstract

Psychiatric comorbidity is high among patients with epilepsy, found more frequently with right-sided seizure foci. Neurosurgical intervention is often the standard of care for refractory epilepsy; unfortunately, psychiatric symptoms can impact a patient's compliance and participation in the pre-surgical process. This pre-surgical epilepsy case illustrates the importance of neuropsychological evaluation in clarifying the relationship between cognitive functioning and long-standing psychiatric comorbidities to inform surgical candidacy. A 20-year-old, left-handed, bilingual Caucasian female with seven years of education with cortical dysplasia associated with intractable right-hemisphere localization-related epilepsy underwent neuropsychological evaluation for progressive short-term memory and word-finding difficulty as part of a pre-surgical workup. A clinical interview, neuropsychological testing, and comprehensive review of available electronic medical records (EMR) were completed. Neuropsychological estimates of current intellectual functioning were low average but variable, revealing a relative strength in non-verbal learning and memory compared to verbal abilities. Self-report emotional measures evidenced clinically elevated levels of anxiety and depression and reduced quality of life due to epilepsy. Psychiatric diagnoses included attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, oppositional defiant disorder, and panic attacks. EMR and clinical interview indicated medication non-compliance, alcohol intoxication, dysregulated sleep hygiene, seizure-related injuries, and history of status epilepticus. Consistent with the literature, this pre-surgical case demonstrated significant psychiatric symptoms in the context of right-sided treatment refractory epilepsy. While psychiatric comorbidities contributed to non-adherence with medical recommendations, under-functioning in vocational goals, and general hopelessness, the neuropsychological evaluation revealed strengths that impacted surgical candidacy and rapport-building that facilitated patient engagement and understanding of the surgical process.