The role of neuropsychology in stereo-EEG: A narrative review

Stereo-EEG is accompanied by unique neuropsychological challenges in the workup, during the admission, and following the procedure. While established principles from epilepsy surgery programs provide a guiding framework for clinical practice, specialized guidelines to inform the role of neuropsychology in stereo-EEG warrant further consideration. In this review, we consider the role of neuropsychological assessments in assisting with localization of the epileptogenic network in the context of discordant noninvasive investigations, the paucity of research examining the cognitive risks associated with radiofrequency thermocoagulation, and the role for neuropsychological counseling in stereo-EEG. Through a narrative review, we then critically appraise the current literature surrounding the challenges of cognitive examination during cortical stimulation and subsequent clinical interpretation of elicited deficits. Overall, we propose a model of practice for clinical neuropsychology within stereo-EEG programs that includes neuropsychological assessment, neuropsychological counseling, and neuropsychological involvement for cortical stimulation. PLAIN LANGUAGE SUMMARY: Stereo-EEG is a complex investigative procedure that may be undertaken in people with drug-resistant epilepsy. Clinical neuropsychologists can help assess the cognitive risks and benefits associated with the procedure, in turn supporting patients to make informed decisions about their treatment options. Despite this, the role of clinical neuropsychology in stereo-EEG programs has been largely overlooked. As such, we propose a framework that highlights the clinical utility of neuropsychology before, during, and after stereo-EEG.