In response: Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013-2017.

Abstract

Dear Editors, We thank Dr. Reilly for his thoughtful and positive comments on the recent report of the International League Against Epilepsy (ILAE) Neuropsychology Task Force on indications and expectations of neuropsychological assessment in routine epilepsy care.1 Dr. Reilly has raised some important issues with which the Task Force agrees. First, he points out the high rates of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children with epilepsy, and the recent recognition of the impact of these disorders in adults with epilepsy. In response to these high rates he recommends routine screening of children with epilepsy for these disorders, and we concur that early identification is key to the effective management of these children. In some centers, this screening will be done by neuropsychologists, whereas in others, it may be carried out by neurologists, developmental pediatricians, school psychologists, psychiatrists, epilepsy nurses, or other healthcare staff. Second, Dr. Reilly emphasizes the need for psychoeducation to be provided to school and educational staff about the nature and implications of the neuropsychological assessment results. We agree that this practice provides an ideal way of supporting the child in the school setting, and in keeping with this, pediatric neuropsychologists commonly consult with school personnel about the results of their assessments and their implications for the child's academic and psychosocial educational programs. Additional information about the nature of epilepsy is also often warranted. In our experience, teachers and school administrators often have a fear of epilepsy, which can be addressed through education and a seizure safety plan. Epilepsy nurses or community epilepsy support associations are frequently engaged in this type of education. This education is extremely important, because without it, the school may focus on the seizures and place the child's academic and behavioral needs secondary. Third, Dr. Reilly discusses the role of the psychologist beyond the neuropsychological assessment. We entirely agree with this point, and have written of the importance of evaluating the patient and family members for the impact of epilepsy on a range of psychological and psychosocial domains (please see p. 679 of the report, section headed “Psychological assessment”).1 As noted by Dr. Reilly, this includes helping parents of children with epilepsy recognize the impact it has on their own psychological well-being and mental health, and to seek treatment and support where necessary. We would like to thank Dr. Reilly for highlighting these three important issues, which are particularly relevant to paediatric neuropsychological assessment in the routine care of children with epilepsy. None of the authors has any conflict of interest to disclose. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Sallie Baxendale (Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom), William Barr (Departments of Neurology & Psychiatry, NYU School of Medicine, New York, New York, U.S.A.), Sherifa Hamed (Department of Neurology & Psychiatry, Assiut University Hospital, Assiut, Egypt), John Langfitt (Departments of Neurology & Psychiatry, University of Rochester Medical Center, Rochester, New York, U.S.A.), Séverine Samson (Epilepsy Unit, la Pitié-Salpêtrière Hospital, Paris, France and Neuropsychology and Auditory Cognition, University Lille-Nord de France, Lille, France), Masako Watanabe (Department of Psychiatry, The National Center of Neurology & Psychiatry, Tokyo, Japan), Gus A. Baker (University Department of Neurosciences, Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom), Christoph Helmstaedter (Department of Epileptology, University of Bonn, Bonn, Germany), Bruce P. Hermann (Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.), and Mary-Lou Smith (Department of Psychology, University of Toronto Mississauga and Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada).