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We explored the current practice with respect to the neuropsychological assessment of surgical epilepsy patients in European epilepsy centers, with the aim of harmonizing and establishing common standards. Twenty-six epilepsy centers and members of "E-PILEPSY" (a European pilot network of reference centers in refractory epilepsy and epilepsy surgery), were asked to report the status of neuropsychological assessment in adults and children via two different surveys. There was a consensus among these centers regarding the role of neuropsychology in the presurgical workup. Strong agreement was found on indications (localization, epileptic dysfunctions, adverse drugs effects, and postoperative monitoring) and the domains to be evaluated (memory, attention, executive functions, language, visuospatial skills, intelligence, depression, anxiety, and quality of life). Although 186 different tests are in use throughout these European centers, a core group of tests reflecting a moderate level of agreement could be discerned. Variability exists with regard to indications, protocols, and paradigms for the assessment of hemispheric language dominance. For the tests in use, little published evidence of clinical validity in epilepsy was provided. Participants in the survey reported a need for improvement concerning the validity of the tests, tools for the assessment of everyday functioning and accelerated forgetting, national norms, and test co-normalization. Based on the present survey, we documented a consensus regarding the indications and principles of neuropsychological testing. Despite the variety of tests in use, the survey indicated that there may be a core set of tests chosen based on experience, as well as on published evidence. By combining these findings with the results of an ongoing systematic literature review, we aim for a battery that can be recommended for the use across epilepsy surgical centers in Europe., (Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.)

Purpose: To investigate cognitive outcomes after frontal lobe resection (FLR) for epilepsy in a consecutive single centre series., Methods: Neuropsychological examinations were performed prior to and two years (mean test interval 2.5 years) after surgery in 30 consecutive patients who underwent FLR. Cognitive outcome was evaluated with particular consideration to the site of surgery (lateral, premotor/SMA [supplementary motor area], mesial/orbital). Cognitive domains assessed were speed, language, memory, attention, executive functions and intelligence. 25 healthy controls were assessed at corresponding time points (mean test interval 3.0 years). Analyses were made both at group and individual levels., Results: At baseline the patients performed below controls in variables depending on speed, executive functions, global and verbal intelligence. Two years after surgery, the analyses at the subgroup level indicated that the lateral resection group had less improvement than the controls in global intelligence, FSIQ (p=.037). However, at the individual level, the majority of the change scores (74-100%) were classified as within the normal range for all but one variable. The exception was the variable "Comprehension" (measuring verbal reasoning ability) with reliable declines in 44% (8/18) of the patients. This pattern of decline was observed in the lateral (4/7 patients) and premotor/SMA (4/7 patients) resection groups. Seizure outcome and side of surgery did not influence these results., Conclusion: The main finding was cognitive stability at group level two years after FLR. A reliable decline in verbal reasoning ability was rather common at an individual level, but only in the lateral and premotor/SMA resection groups. The lateral resection group also had less improvement than the controls in global intelligence., (Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

• Patients who have gone through FLR show difficulties with decision-making under ambiguity. • They fail to learn from feedback throughout the Iowa Gambling Task. • Decision-making under ambiguity was not correlated to results in executive tasks. Decision-making is crucial to daily life and can impact our society as well as economic conditions. Although the frontal lobes have been identified as important for decision-making, this capacity has only been studied to a limited extent in frontal lobe epilepsy and not at all after frontal lobe resection (FLR) for epilepsy. This study aimed to explore decision-making under ambiguity after FLR for epilepsy. Fourteen patients having undergone FLR for epilepsy completed the Iowa Gambling Task (IGT) which is a widely used tool to measure decision-making under ambiguity. Iowa Gambling Task scores included in the analysis were: total net score, separate scores from five blocks across the test, and a change score (last block of IGT minus first block). A group of healthy controls (n = 30) was used as a comparison. Associations between IGT and standardized neuropsychological methods for assessment of executive functions, self-rating questionnaires of mental health, fatigue, and behavior linked to frontal lobe dysfunction were also investigated. The patient group performed inferior to controls at the final block of the IGT (p =.001). A group difference in IGT change scores was found (p =.005), reflecting the absence of a positive change in performance over time for the FLR group compared to the control group. Correlations with tests of executive functions as well as self-rating scales were mainly statistically nonsignificant. This study shows that patients having undergone FLR for epilepsy have difficulties with decision-making under ambiguity. The performance illustrated a failure to learn throughout the task. Executive as well as emotional deficits may impact decision-making processes in this patient group and need to be considered in further studies. Prospective studies with larger cohorts are needed. [ABSTRACT FROM AUTHOR]

• Positive as well as negative emotional and psychosocial experiences were described by both patients and relatives. • Seizure freedom gave rise to a newfound autonomy and a more grown-up identity. • Mental fatigue was experienced to be associated with social withdrawal, even when seizure freedom was obtained. • Coping strategies included planning ahead to avoid mental exhaustion. Frontal lobe resection (FLR) is the second most common epilepsy surgery procedure in adults. Few studies address neuropsychological consequences after FLR. The aim of this study was to explore patients' and relatives' experiences of cognitive, emotional and social cognitive functioning after frontal lobe epilepsy surgery. Semi-structured interviews were held with 14 patients having gone through FLR as adults during the years 2000–2016 and 12 of their relatives. Interviews were audio-recorded, transcribed and analyzed with inductive qualitative content analysis. Positive as well as negative consequences were described both by patients and relatives. Feelings of relief and an increased capacity to experience emotions of well-being were mainly experienced as related to seizure freedom. A newfound autonomy and a more grown-up identity as opposed to a self-image based on epilepsy was also highlighted. However, results also showed that even for seizure free patients, FLR could give rise to negative experiences, the most prominent of which were mental fatigue, lowered mood and social withdrawal. Coping strategies included planning ahead to avoid mental exhaustion. Over all, respondents considered that the epilepsy surgery had been a risk well worth taking and that positive consequences outweighed the negative ones. This study shows a range of positive as well as negative outcomes after FLR for epilepsy. The findings indicate that lowered mood and mental fatigue could affect the life situation in a negative way, regardless of seizure outcome. This is important to consider in the preoperative counselling of patients and their families, as well as in the postsurgical follow-up. It is also crucial that the epilepsy surgery team has the possibility to offer rehabilitation and support to families regarding these aspects after surgery. [ABSTRACT FROM AUTHOR]