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Computerized neuropsychological testing in epilepsy: overview of available tools (July 2013)

Markus Reuber, editor-in-chief, SeizureIntroduction from Dr Markus Reuber, editor-in-chief of Seizure

Seizure 22/6 has published Computerized neuropsychological testing in epilepsy: overview of available tools

For the last sixty years at least, neuropsychology has been a key feature of comprehensive epilepsy care: if it had not been obvious before, the bilateral removal of Henry Gustav Molaison's hippocampal formation and adjacent structures including most of the amygdaloid complex and entorhinal cortex in 1953, and the extensive research carried out by Brenda Milner and Suzanne Corker on "H.M." (as he became subsequently known)clearly demonstrated the important role these structures have, in which many patients' seizures start. Suzanne Corker's recent book has created a fitting memorial for H.M.'s enormous contribution to our understanding of the memory system and the huge progress in field of neuropsychology over the last half-century (1). However, whilst neuropsychologists have proven how their input can reduce the risk of poor functional outcomes after epilepsy surgery, how they can tease apart the effects of epilepsy, underlying brain lesions, affective disorders and antiepileptic drugs on functions such as attention, processing speed and memory, and although patients greatly appreciate the detailed diagnoses and advice which neuropsychologists are capable of giving, neuropsychology remains a somewhat troubled specialty in many countries. Neurologists often have much easier access to brain scans (and repeat brain scans) or even to inpatient monitoring with video-EEG than to neuropsychological assessments. In many cases healthcare providers will more readily pay for second or third medical opinions than for a single neuropsychological assessment. In the current climate, characterized by cut-backs or an increasing emphasis on healthcare cost controls, funding for neuropsychological assessments is at particular risk. Neuropsychology is still seen as a bit of a luxury.

The reasons for this perception are likely to include that neuropsychologists are highly trained health professionals (and therefore a relatively rare breed), and that a thorough assessment by a fully trained neuropsychologist is not cheap. These two arguments alone would be good reasons for exploring the possibility of replacing at least some of the time-consuming tests which neuropsychologists have traditionally carried out in face-to-face interaction with computer tests. One such procedure called "Computerized Cognitive Testing in Epilepsy" (CCTE) is presented in this issue of Seizure (2).

My Editor's Choice in this issue of Seizure is the review by Witt, Alpherts and Helmstaedter which lists other advantages of computer tests than cost or access limitations, describes the scope of computer tests in the evaluation of patients with epilepsy but also discusses the drawbacks (3). It is likely that many of the current paper and pencil tests administered in a face-to-face setting will be replaced by computer tests over the next decade or two. However, there is still a lot of work to do to optimise the procedures for the kind of things most relevant in the assessment of patients with epilepsy and to validate them in this patient group. And neuropsychologists don't need to fret: it is unlikely that their work will ever be fully replaced by a computer. Out patients are much too complex for that.

[1] Corkin, S. Permanent Present Tense: The Unforgettable Life of Amnesic Patient, H.M.. New York: Basic Books, 2013.

[2] Kurzbuch, K., Pauli, E., Gaál, L., Kasper, B.S., Kerling, F., Stefan, H., Hamer, H., Graf, W.. Computerized Cognitive Testing in Epilepsy: A new method of cognitive screening. Seizure 2013

[3] Witt, J.-A., Alpherts, W., Helmstaedter, C.. Computerized neuropsychological testing in epilepsy: overview of available tools, Seizure 2013:22:416-423

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