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

Abstract

To the Editors: Psychology has long made a valuable contribution to the understanding of the impact of epilepsy on psychosocial functioning. The recently published report of the International League Against Epilepsy (ILAE) Neuropsychology Task Force, Diagnostic Methods Commission 2013–20171 is to be welcomed and continues in this tradition. The authors do an excellent job in highlighting the contribution of neuropsychological assessment to individuals with epilepsy. The authors importantly point out that all children and adults with new-onset epilepsy should be screened for cognitive and behavioral difficulties, with accompanying advice on the risks of these conditions in epilepsy. There are three areas not explicitly alluded to in the report that warrant further comment. In relation to psychological assessment, the authors specifically mention the high comorbidity of depression and anxiety in epilepsy and the need for routine screening for these disorders. It is important to note that autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) may be the most common neurobehavioral comorbidities in childhood epilepsy,2, 3 and features of these neurodevelopmental disorders are being recognized increasingly as part of the spectrum of neurobehavioral difficulties in adults with epilepsy.4, 5 Furthermore, both ASD and ADHD are often underrecognized in childhood epilepsy.2 Therefore, routine screening for these disorders is warranted, at least in childhood, and should be specifically named as part of the core psychological domains considered. With respect to assessment results, the authors point to the importance of providing psychoeducation about the nature and implications of assessment results to patients and families. It is essential also, where possible, that psychoeducation is provided to school/educational staff about assessment results and implications. Knowledge of epilepsy and associated comorbidities in schools can be varied. Staff in educational settings may feel confident dealing with epilepsy only when someone perceived to be an expert about the condition provides the advice.6 If supporting neuropsychologists can communicate with schools about the results of neuropsychological assessment findings and provide psychoeducation, it is more likely that staff will understand assessment implications and provide appropriate support to affected children. As a final point, it is important to point out the role that psychologists can play beyond neuropsychological assessment. Although perhaps beyond the scope of this report, psychologists can play a significant role in supporting families affected by epilepsy. For example, psychologists are likely to be well poised to help parents of children with epilepsy recognize when they themselves have mental health difficulties, which are often present in parents of children with epilepsy. I have no conflicts of interest to disclose. I confirm that I have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.