Neuropsychology
Not only epileptic seizures, but also cognitive deterioration can negatively influence the people who suffer from epilepsy. The type and severity of functions depression can be precisely determined within the framework of neuropsychological examination. The important therapeutic conclusions are based on the results of neuropsychological examination.
Neuropsychological examination includes the detection of all possible changes in the psychological functions in case of neurological diseases. The most frequently examined cognitive abilities are mnemonic function and memory function, language skills and visual-spatial skills as well as such advanced mental functions as problem solution and deductive thinking. These activities are tested by means of the so-called “paper and pencil” research method or more precisely defined with the help of computer equipment. Depending on the statement of a question the examination can last several hours. Besides that on the basis of questionnaires the information about the psychological state and the quality of life, which can influence the acquired abilities, can be collected.
Cognitive deterioration among the patients with epilepsy can have various interconnected reasons:
- In case if the structural brain damage is the reason of epilepsy, the functions of the affected areas can be significantly reduced.
- The epileptic seizures can put a crimp in some activities; and in this case the type of seizure, its length and frequency play the vital role.
- Antiepileptic drugs, as well as other substances which influence the central nervous system can become a reason of intellectual incapacitation. These derangements subside as soon as the drugs administration is limited.
Neuropsychological examination
... as a part of preoperative diagnostics of epilepsy
Within the framework of the preoperative diagnostics the patients are subject to the neuropsychological examination alongside with other checkup procedures. During the neuropsychological examination such abilities as attention, memory, language, visual processing and increased cognitive functions are checked in order to determine the connections between the indexes deficit and the structural damages, i.e. epileptic focus.
Frequently it is interesting to examine the dominant hemisphere in speech activity in order to classify the results of the research and evaluate the risks before the planned operative intervention. In this case the method of functional magnetic resonance tomography (fMRT) is often used. With the help of fMRT the brain activity is registered while various language tasks are being fulfilled. There is an example of the left-side speech dominance below. Besides that there is an opportunity to conduct Wada-test which, as a method of deactivation, can define the speech lateralization.
The following aim of the preoperative neuropsychological examination is the evaluation of the possible risks during the planned operative intervention as well as the influence of possible functional impairments on overcoming the obstacles in work and everyday life. Besides that in Freiburg, alongside with the neuropsychological conclusions assessment, the functional integration of the excisable area is additionally examined by means of fMRT within the framework of the diagnostics.
At the final stage the post-surgical rehabilitation measures and their results should be discussed. In order to evaluate the post-operative course of disease, after the surgical intervention in case of epilepsy, two neuropsychological follow-up examinations are conducted (in 3 and 12 months after the surgical intervention).
... monitoring of side effects of drugs
With the help of neuropsychological examination the changes in the functional productivity caused by the administration of the new medication can be determined. Besides that before the dosed drugs administration the examination of the main abilities is made. The results of this examination will be further compared to the results of the re-examination which will be conducted as soon as the dose of the new medication is enhanced. In case if the functional productivity is decreased during the administration of the antiepileptic drug, with the concurrence of the patient and the neurologist in charge, the dose of the medication will be limited or the administration of the drug will be suspended.
Within the framework of the first examinations the use of the handheld computer gave a good account of itself. The handheld computer is used to register, for instance, the diurnal variability and the functional changes of productivity at various stages of drugs dosing. Such form of mobile monitoring lets the doctors keep record of the changes of functional productivity and emotional state in usual life while performing routine tasks.