We aim to highlight a unique case that required adaptation of a neuropsychological battery used as part of a pre-surgical workup for medically refractory epilepsy, to meet the needs of a culturally and linguistically-diverse patient with visual impairment.

Comprehensive pre-surgical neuropsychological evaluation for a 34-year-old Spanish-speaking patient with a past medical history of epilepsy, hydrocephalus, and a subependymal giant cell astrocytoma resection, with subsequent complete blindness. EEG findings demonstrated abnormal left frontal dysfunction. A neuropsychological evaluation was conducted utilizing components from the Neuropsychological Screening Battery for Hispanics (NeSBHIS) as well as additional supplemental Spanish language assessments. Due to the patient’s visual impairment, visuospatial measures were unable to be utilized. Hand dynamometer was used in place of the Grooved Pegboard Test.

Results from the evaluation indicated a generally intact cognitive profile with a few observed deficits. Relative and normative weaknesses were identified on tasks of verbal learning. His initial learning of a list of orally presented words was in the Low Average range, where he demonstrated a positive though somewhat flat learning profile. His performances on short- and long-delay free recall tasks were in the Exceptionally Low range. With a recognition format, he performed within normal limits and made no false positive errors. Importantly, during the initial learning of the word list, the patient demonstrated a significant number of repetitions (13) and semantically related intrusions (6). These likely led to downstream difficulties encoding information; however, he displayed a minimal loss of information over a delay. Similarly, his immediate and delayed recall of an orally presented story fell in the Exceptionally Low range. Additional relative weaknesses were observed on tasks of working memory (Low Average range) and on a task of phonemic fluency (Below Average range). This performance was a notable contrast to his performance on tasks of semantic fluency, which ranged from the Low Average to Average range. On a task of motor functioning, grip strength performances were intact bimanually (Low Average to Average range) without a significant asymmetry between his left and right hands. Lastly, formal assessment of emotional functioning on self-report measures revealed minimal depression, minimal anxiety, and no significant quality of life concerns.

Taken together, the weaknesses observed in the domains of verbal learning, working memory, and phonemic fluency, in addition to the learning profile observed during the verbal encoding task, suggest that his overall profile is indicative of dominant frontal systems dysfunction. This finding was concordant with prior EEG and MRI studies. Notably, given the patient’s visual impairment, visuospatial measures were unable to be utilized, and lateralization was unable to be fully assessed given the abbreviated battery. The neuropsychological battery used for this evaluation was based on established guidelines, and while there were limitations in administration of the present battery, it is imperative to highlight the necessity and feasibility for adaptation of protocols to best capture data in culturally-underrepresented and visually impaired populations.

Responsive neurostimulation (RNS) is a surgical intervention to reduce the frequency of seizures as an adjunctive therapy for patients with drug-resistant epilepsy (DRE). Presurgical neuropsychological evaluations capture symptoms of anxiety and depression, which occur in higher rates within the epilepsy population than in the general population; however, the effects of mood are commonly overlooked or underappreciated in the conceptualization of cognitive functioning and overall quality of life. Previous studies have shown the effects of attentional control and executive functioning on engagement in meditative states. The present study examines pre and post-meditation self-reported anxiety symptoms and the electrophysiological changes captured intracranially during meditation sessions in patients implanted with an RNS device. This study seeks to utilize presurgical neuropsychological evaluations to explore relationships between cognitive profiles and meditative state changes, and reductions in anxiety.

This study presents a series of 10 patients who underwent RNS device implantation for the treatment of DRE at Mount Sinai Hospital. All patients had at least one contact in the basolateral amygdala. Prior to surgical implantation of the RNS device, all patients completed a comprehensive neuropsychological evaluation based on the NIH Common Data Elements Battery for Epilepsy Patients. Patients in this study completed a 17-and 22-minute meditation protocol based on loving-kindness and Focal Awareness (FA) meditation. Control points and mind-wandering phases were utilized to distinguish the meditative portion of the study during intracranial recordings. All patients completed a pre- and post-meditation questionnaire adapted from the PROMIS Anxiety Short Form as well as self-ratings on meditation depth and satisfaction.

Presurgical neuropsychological evaluation of patients showed elevated levels of anxiety on the BAI (M = 18.14, SD = 12.03) and depression on the BDI-II (M = 15.57, SD = 6.92). Neuropsychological findings localized to frontal or frontotemporal deficits in 80% of the patients were captured in this study. Regarding lateralization, 50% of patients presented with bilateral weakness on neuropsychological evaluation, with the rest showing unilateral profiles. A negative correlation was observed between patient responses on pre-meditation anxiety measures and self-reported depth of engagement in meditation, r = -0.65, p = .043. When all meditation sessions were evaluated, patients displayed a reduction in anxiety levels pre- and post- meditation, t = 2.3, p = .03.

Present findings suggest a reduction in anxiety symptoms following completion of a meditation paradigm. Additionally, a relationship between anxiety and depth of engagement in meditation was identified. During each meditation session, electrocorticography data was collected and analyzed. Given the high comorbidities of anxiety and depression as well as cognitive symptoms common for individuals with epilepsy, a systems-based approach may enhance conceptualization of neuropsychological and neuropsychiatric evaluations, which may have a significant clinical impact. Evaluation of neuropsychological profiles, meditation effects, and anxiety in this population may support cross-discipline understanding of cognitive and psychiatric profiles to better inform treatment recommendations.

Epilepsy is one of the most common neurological disorders affecting young people globally. While up to 60% of seizures experienced during childhood will resolve, childhood epilepsy can give rise to long-lasting neuropsychological effects which extend far beyond those attributed to seizure activity. While these effects have been explored extensively using quantitative methodologies, little research has examined the lived experience of epilepsy in childhood. The aim of the present study was to capture adults' retrospective insights into the impact of epilepsy throughout their schooling years.

Participants consisted of Irish adults between 18 and 35 years, who had their first seizure on or before the age of 16 years. Participants were recruited from epilepsy support agencies and social media, and self-referred to the study. A bespoke semi-structured interview protocol was developed in collaboration with a patient expert which explored learning experiences, relations with peers, and participants' understanding and support of epilepsy during childhood. The methodology adopted a fully qualitative approach to reflexive thematic analysis. Therefore, patterns across the data were examined whilst taking into consideration the wider social context in which the data were generated. Latent assumptions that may have underpinned participants' experiences were prioritised and data was interpreted using pre existing theories and/or concepts. Interviews were completed following the original abstract deadline, and data analysed thereafter.

Thirteen adults who experienced epilepsy during childhood in Ireland were interviewed. Three primary themes and 14 subthemes were generated from the data. The primary themes were that of (1) disenfranchised grief, (2) the need to belong and (3) meeting the child where they're at. Adults reflected that, as children, the diagnosis of epilepsy evoked feelings typically associated with bereavement or loss. Although adults described childhood epilepsy as isolating, these feelings were countered by the support of friends, family and others with epilepsy, as participants recalled finding their tribe. Participants also called for developmentally appropriate practice when dealing with children and their families, across clinical and educational settings, in order to facilitate more comprehensive understandings of epilepsy and its consequences.

Retrospective qualitative research offers a unique opportunity to explore changes in perception those with childhood epilepsy over time. The present study highlights the need for developmentally appropriate practice, which takes the child's neuropsychological and developmental standing into consideration, when supporting for young people with epilepsy. Given the dearth of research in this field, further retrospective research is needed to fully comprehend the impact of epilepsy in childhood globally.