Epilepsy and Neuropsychology: Past, Present, and Future

Abstract

The field of neuropsychology has provided important contributions to the study of epilepsy for more than 70 years. The role of a neuropsychologist in an epilepsy center setting is likely to have been created by psychologist Molly Harrower, who worked in collaboration with Wilder Penfield, the renowned neurosurgeon, during the late 1930s. Harrower’s adaptation of commonly-used assessment measures, such as IQ tests, the Rorschach, and various visual paradigms provided some of the first examples of using psychological tests to assess the effects of localized brain dysfunction in patients with seizures (HarrowerErickson 1941). Her work with Penfield at the Montreal Neurological Institute was accompanied by important studies by Donald Hebb and colleagues on the effects of frontal brain resection (Hebb and Penfield 1940), and followed by the pioneering work of Brenda Milner in the 1950s, whose insights into the effects of temporal lobe resection have guided the work of other neuropsychologists for over 50 years (Milner 1954, 1967). At the same time, other studies on the effects of temporal lobe surgery were being conducted in London by psychologist, Aubrey J. Yates, in collaboration with a team of neurologists and surgeons at the Guys-Maudsley Hospital (Meyer and Yates 1955). Work in the United States followed, with a number of important studies conducted in the 1960s and 1970s by Alan Mirsky, Charles Matthews, Hallgrim Klove, and Ralph Reitan, using novel tests or a structured neuropsychological test battery to evaluate the effects of seizures and other epilepsy variables on patients’ cognitive functioning (Klove and Matthews 1974; Mirsky and Van Buren 1965; Reitan 1974). This work continued in North America into the following decades with the valuable contributions of Carl Dodrill, Marilyn Jones-Gotman, Rebecca Rausch, and Bruce Hermann, using a variety of neuropsychological approaches (Dodrill 1981; Hermann et al. 1987; Jones-Gotman 1986; Rausch and Crandall 1982). Cognitive and emotional symptoms are now considered common in patients with all forms of epilepsy. It is known that more than half of patients with epilepsy report significant levels of memory impairment (Thompson and Corcoran 1992). Elevated rates of depression and anxiety are also seen in this population (Devinsky et al. 2005). Neuropsychologists, recognized by other professionals as playing a unique and important role in evaluating these conditions are considered key personnel for epilepsy centers across the United States (Walczak et al. 2001). Results from a worldwide survey have indicated that clinical neuropsychologists are employed in 89% of specialized epilepsy centers (ILAE Report 1997). In a consensus statement prepared by the National Institutes of Health (NIH), it was concluded that psychological tests are “essential” for evaluating cerebral functions in patients prior to and following epilepsy surgery (NIH 1990). Cognitive functioning is now recognized as a critical component of quality of life in patients with epilepsy and is now included with seizure control as an important outcome variable in research studies on the efficacy of medication treatment in addition to the effects of resective surgery. Neuropsychol Rev (2007) 17:381–383 DOI 10.1007/s11065-007-9045-7