Presurgical and postsurgical psychological assessment in epilepsy. Clinical case study

Abstract

Introduction. Epilepsy surgery represents a valuable treatment for people with drug-resistant epilepsy, which often leads to substantial improvements in the cognitive-behavioral domains and to a better quality of life, especially for children. In this context, the presurgical psychological assessment in combination with other relevant investigations are important for assessing the risk of potential postsurgical deficits, determining the dominant hemisphere for language function; predicting the risk of memory decline and the visual and motor deficits. Objective of the study: to assess the strengths and weaknesses in the presurgical and post-surgical cognitive domain, to compare the results and to evaluate the degree of improvement or decline in the post-surgical cognitive domain. Material and methods: one patient was evaluated, a child, 11 years old, left-handed. The study took place at Institute of Emergency Medicine, National Center for Epileptology during 2019-2020. We applied 6 presurgical and postsurgical tests to assess cognitive function: The Raven's Progressive Matrices test; Rey auditory-verbal memory test; REY complex figure visual memory test; COWAT test for verbal fluency, the Cube coping test and the Clock drawing test. Results: the psychological assessment emphasized a postsurgical improvement of cognitive abilities, with an increase of nonverbal intelligence and immediate recall in verbal memory, a slight decline in the language, verbal memory - delayed recall and visual memory domains associated with difficulties in coping the cube and drawing the clock. The neuropsychological test results are presented in table 1 and 2. Presurgical psychological assessment The primary role is to assess all cognitive, emotional and behavioral domains and to use the results to establish a baseline assessment against which cognitive change can be measured after the surgery. Postsurgical psychological assessment Is necessary in evaluating the outcome because cognitive decline is one of the most significant sequelae of the epilepsy surgery. The postoperative assessment should address all aspects of cognitive and behavioral function, as assessed prior to the surgery. Clinical Case Report Patient M.A. a child, 11 years old, left-handed. The patient was followed by his epileptologist for a psychological assessment because of his two epileptic seizures and the diagnostic of a tumour in the temporal-parietal left hemisphere. As a result, the patient underwent an epilepsy/tumour neurosurgery. To assess the risk of cognitive decline, emotional and behavioural risk, the patient's cognitive function was evaluated before and 6 months after neurosurgery. The psychological assessment was comprised of 6 presurgical and postsurgical standartized tests. Conclusions A psychological assessment is considered mandatory and should form an integral component of the presurgical evaluation and assessment of postoperative outcome for all epilepsy surgery patients. In our case study, before the surgery, the psychological assessment revealed impairment in visual spatial skills, namely in the clock drawing and cube coping test. His performance was borderline, with soft decline on measures of psychomotor processing speed, confrontation naming and semantic fluency. Otherwise, the verbal, visual memory and intelligence level was in the normal limits. Postsurgically, we noted an improvement in intelligence level and visual spatial skills, a slight decline but in normal limits in verbal and visual memory. In conclusion we can affirm that epilepsy surgery provided seizure freedom, improvement of intellectual level, positive changes in behavioral and emotional domains and a better quality of life of the patient and his family.