Specialty Program

Neurocognitive Program

Neuropsychological Testing
Clinical neuropsychology assesses brain functioning through standardized tests and observations. Intelligence, memory, language, executive functioning, attention, visuospatial/visuomotor functions, and other abilities are assessed. This evaluation can be given as part of a pre-surgical or post-surgical epilepsy work-up; to test a patient’s reported problems with focusing or memory; or to diagnose dementia, an attention deficit disorder, autism, or a learning disorder, among other issues. Testing sessions usually last 3 to 5 hours and are performed by a neuropsychologist (a licensed psychologist with special training in pediatric and/or adult assessments). Once testing is completed, the neuropsychologist interprets the results and writes a report that will be made available to the patient and the referring doctor. A feedback session at a later date is also scheduled, during which results, diagnostic impressions, and recommendations are discussed with the patient and, often, their family. Neuropsychological evaluations in our program are offered in English and Spanish. Types of evaluations conducted include, but are not limited to:

Pre- and Post-Surgical Epilepsy Evaluations (for both pediatric and adult patients)
If an individual is considered a possible candidate for epilepsy surgery, a presurgical neuropsychological evaluation is performed as part of a comprehensive presurgical workup in order to assess the patient’s cognitive strengths and weaknesses and to provide a baseline with which to compare future postsurgical functioning. Results of the presurgical evaluation may also shed light on lateralization of seizures (i.e., whether the findings are consistent with a right or left hemisphere seizure focus and are consistent with all other obtained data). Results are also used to help neurosurgical planning to attempt to avoid cognitive decline postoperatively, particularly in the area of language. In addition to standard neuropsychological testing, Wada and/or cortical brain mapping procedures are sometimes performed to help decrease the likelihood of postoperative cognitive decline. Six to 12 months following epilepsy surgery, individuals are then referred for a postsurgical neuropsychological evaluation to assess for any changes in cognitive functioning that may have occurred as a result of the surgery. The results of the postsurgical evaluation can be used to determine if there are needs for therapy, cognitive rehabilitation, academic accommodations, or vocational counseling.

Memory Disorder Evaluations
At Epilepsy America, our neuropsychologists are specialized in the assessment of adults and older adults with memory complaints. Memory complaints is the primary reason for an adult individual to initially see a neurologist and be referred for neuropsychological evaluation. As with all of our neuropsychological assessments, a thorough clinical interview with the patient (and preferably someone who knows the patient very well and can report on possible changes in functioning), a review of medical records, and comprehensive formal testing are performed to evaluate these complaints. Results can reveal whether an individual’s complaints regarding their memory are normal (i.e., age-related changes), whether they might be due to an underlying neurological condition (e.g., epilepsy, dementia, Mild Cognitive Impairment, etc.), or whether there is another likely explanation for their complaints (e.g., psychological stressors, clinical depression, medication side effects, metabolic or endocrine functioning abnormalities, etc.).

Brain Injury Evaluations
An impact to the head can result in a traumatic brain injury (TBI) that affects a person’s cognitive functioning. Frequent causes of TBI include motor vehicle accidents, injuries involving a blunt object to the head, sports injuries, or falls from a significant height. However, any situation in which the head is traveling at an accelerated pace and meets with an abrupt deceleration upon impact or is struck by another object can be sufficient enough to cause an injury to the brain. A TBI may be mild, moderate, or severe. These classifications are derived from several different factors, including length of post-traumatic amnesia (PTA), length of loss of consciousness (LOC), and initial score on the Glasgow Coma Scale (GCS). One of the physical consequences of TBI is post Traumatic epilepsy (PTE). The incidence of PTE accounts for about 20% of epilepsy in the general population and 5% of all epilepsy cases. Many individuals report persistent difficulties with memory, attention/concentration, problem-solving, speed of information processing and other aspects of cognitive functioning long after their physical status has stabilized. There are also often personality changes involving moodiness, sensitivity, irritability, and reduced frustration tolerance. Neuropsychological assessment can be useful in determining the nature and extent of cognitive difficulties post-TBI. Once the problem areas can be identified, the neuropsychologist can help determine residual functioning (i.e., post TBI strengths and weaknesses) and prognosis as well as make recommendations for treatment. Recovery to the highest possible level of functioning is often facilitated with cognitive rehabilitation and other therapies and undergoing a neuropsychological evaluation is the first step in beginning this treatment process.

Autism-Spectrum Disorder
Epilepsy occurs in about 10-30% of patients who are diagnosed with autism. Autism spectrum disorders consists of a pattern of significant and pervasive impairment in social interaction and communication skills and the presence of stereotyped behaviors, interests, and activities. A diagnosis is made on the basis of a structured interview and standardized assessment using both behavior rating scales and direct testing and observations. Neuropsychological assessment, using standardized measures and other tests of cognition, academic, and social-emotional functioning, is often used to derive a diagnosis. Rating scales (i.e., Gilliam Autism Rating Scale, Modified Checklist for Autism in Toddlers), structured interviews (i.e., Autism Diagnostic Interview – Revised), and test measures (Autism Diagnostic Observation Schedule – 2nd edition) aid in diagnosis. Specialized neuropsychologists or developmental neurologists/pediatricians typically make the initial diagnosis. The earlier this diagnosis is made, the sooner adequate behavioral and developmental interventions can be started, which improves prognosis.

Assessment for Learning Disorders and Attention-Deficit Hyperactivity Disorder (ADHD)
A learning disorder is a persistent condition of presumed neurological dysfunction which may/may not exist with other disabling developmental and/or neurological conditions such as epilepsy. It refers to a varied group of disorders that manifest as significant difficulties in the acquisition and use of listening comprehension, speaking, reading, writing, or math abilities. Individuals with learning disorders often struggle in school, and as a result, self-esteem and self-image can suffer. Another type of developmental condition that can co-exist with, or exist independently of, a learning disorder is Attention Deficit Hyperactivity Disorder. This disorder is characterized as a condition in which an individual exhibits signs of developmentally-inappropriate inattention and/or hyperactivity and impulsivity. Early intervention is key in the remediation of developmental disorders such as LD and ADHD. Intervening early on not only increases the chances for a better outcome in terms of remediation but also can minimize the negative cycle of academic and personal struggles that are all too common for children and adults with these disorders. One of the first steps toward early intervention is a clinical neuropsychological assessment, which consists of a review of available school and medical records, a clinical interview, observations of the child during a formal testing session, and standardized, objective testing of cognitive and academic abilities. The evaluation report provides recommendations that are specifically formulated for each individual. Many services/therapies are available to individuals diagnosed with LD or ADHD, such as special education class settings, modified assignments/testing at school, behavioral modification plans, use of learning strategies, tutoring, preferential seating, and extended time on tests and quizzes.

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