Nonidiopathic focal epilepsies: methodological problems for a comprehensive neuropsychological evaluation

In aiming to define better practice parameters for neuropsychological assessment in patients with nonidiopathic partial epilepsies, particularly in children, we discuss the reasons for the current lack of clear answers. The relevant factors include the epilepsy itself, the complexity of the issues related to cognitive function/dysfunction and the underlying developmental processes. Another factor is the lack of availability and high cost of neuropsychological testing, even in industrialized societies. Because of these factors, the need for neuropsychological testing must be considered on an individual basis in the initial evaluation of every child with focal epilepsy; it should be left to the clinician and parents to decide which children will actually be referred. Systematic presurgical and postsurgical testing is important for surgical candidates. Comprehensive research protocols should be designed on a collaborative basis between large epilepsy centers, covering all the essential parameters to be evaluated. Children with focal epilepsies should be included in these protocols from the onset of the epilepsy.