Neuropsychological Testing and Epilepsy
What memory, language and thinking tests can reveal
Epilepsy is usually associated with seizures, but seizures are only one part of how the condition can affect the brain.
Some people with epilepsy experience difficulties with:
memory
concentration
attention
finding words
processing information
planning
problem-solving
learning
or mental fatigue.
A neuropsychological assessment is a detailed assessment of thinking and cognitive abilities.
It does not involve attaching electrodes to the head or scanning the brain.
Instead, a specialist neuropsychologist uses standardised tests and clinical information to build a picture of which cognitive abilities are relatively strong and which are causing difficulty.
Neuropsychological assessment forms part of specialist epilepsy care and can also be an important component of epilepsy-surgery assessment.
What is neuropsychology?
Neuropsychology examines the relationship between the brain and behaviour.
A neuropsychologist may investigate abilities including:
memory
attention
language
reasoning
speed of thinking
visual-spatial skills
executive functions
learning
and aspects of emotional and behavioural functioning.
In epilepsy, the aim is not simply to find out whether someone has a “good” or “bad” memory.
The pattern across many different tasks can provide much more useful information.
For example, somebody may:
learn information normally but forget it unusually quickly
remember visual information better than spoken information
understand words but struggle to retrieve them quickly
have normal memory but poor attention
perform well when information is simple but struggle when several tasks must be managed at once.
These patterns can help clinicians understand what is happening more precisely.
Why might someone with epilepsy be referred?
There are several reasons.
A neuropsychological assessment may be requested when:
the person reports memory problems
family members notice cognitive changes
concentration has deteriorated
school or work performance has changed
there are concerns about medication side effects
doctors want a cognitive baseline
epilepsy surgery is being considered
or doctors want additional evidence about which brain systems may be involved.
Epilepsy Society's current guidance specifically lists memory or concentration concerns, possible medication side effects and helping the medical team understand seizure origin among reasons for referral.
Neuropsychology does not diagnose epilepsy by itself
Neuropsychological testing is not an epilepsy detector.
Someone cannot be given a series of memory tests and diagnosed with epilepsy simply because some scores are low.
Likewise, normal neuropsychological results do not rule out epilepsy.
The assessment provides information that can be combined with:
seizure history
EEG
video telemetry
MRI
medication history
neurological examination
and other investigations.
Its value comes from adding another piece to the overall picture.
Why can epilepsy affect memory and thinking?
There is rarely one single explanation.
Cognitive difficulties can result from a combination of factors.
These may include:
the brain region involved in the epilepsy
repeated seizures
epileptiform activity between obvious seizures
age when epilepsy began
underlying structural brain abnormalities
antiseizure medicines
sleep disturbance
anxiety or depression
fatigue
stress
learning difficulties
and other neurological conditions.
This is why the statement “epilepsy causes memory loss” is too simple.
Two people with the same seizure label may experience very different cognitive effects.
Epilepsy Society notes that epilepsy itself, seizures and treatments can all contribute to memory difficulties.
Memory is not one single ability
When people say:
“My memory is terrible,”
they may actually be describing very different problems.
Memory depends on several stages.
Attention
Information first has to be noticed.
If attention is disrupted, the brain may never properly take the information in.
That can feel like forgetting even though the main problem occurred before memory storage began.
Encoding
The brain needs to organise and register new information.
If encoding is inefficient, the memory may never become strong enough to retrieve reliably.
Storage
Information needs to remain available over time.
Some neurological conditions interfere with retention after information has initially been learned.
Retrieval
Sometimes information is stored but difficult to access when needed.
A person may feel:
“I know it, but I can't get it out.”
These problems require different explanations and sometimes different coping strategies.
What kinds of memory may be tested?
Assessment may examine several forms of memory.
These can include:
Verbal memory
Remembering information presented through language, such as:
word lists
stories
names
or spoken information.
Visual memory
Remembering:
designs
locations
shapes
faces
or other visual material.
Immediate memory
Holding information for a short period.
Delayed memory
Remembering material after a longer delay.
Working memory
Holding and mentally manipulating information, such as remembering several pieces of information while carrying out another task.
A person's pattern across these tests can be more informative than one overall “memory score”.
Language may also be assessed
Epilepsy can involve brain networks important for language.
Tests may look at:
naming objects
understanding words
word retrieval
reading
verbal fluency
comprehension
and other language abilities.
Someone may know perfectly well what an object is but temporarily struggle to retrieve its name.
This is sometimes described as word-finding difficulty.
The location and cause of language difficulties vary, so neuropsychological findings are interpreted alongside the person's neurological history.
Attention and concentration
Attention is essential for almost every cognitive task.
Assessment may investigate:
sustained attention
selective attention
divided attention
resistance to distraction
and ability to maintain concentration over time.
Someone whose attention repeatedly lapses may appear forgetful because information was never fully processed in the first place.
Poor attention can be influenced by:
seizures
medication
fatigue
lack of sleep
anxiety
depression
pain
or other conditions.
Processing speed
Processing speed refers broadly to how quickly someone can take in information and produce an appropriate response.
Slower processing does not mean someone is less intelligent.
A person may understand something accurately but need:
more time to read it
longer to respond
information presented in smaller sections
or fewer simultaneous demands.
Some neurological conditions and medicines can affect processing speed.
Executive functions
Executive functions help us organise and control complex behaviour.
They include abilities such as:
planning
switching between tasks
organising information
inhibiting inappropriate responses
solving unfamiliar problems
monitoring mistakes
and managing several steps towards a goal.
These functions rely heavily on networks involving the frontal lobes but are not confined to one small brain area.
Someone can have good basic memory yet struggle significantly with everyday tasks because planning and organisation are difficult.
Visual-spatial abilities
These involve understanding:
shapes
locations
distances
spatial relationships
and how objects fit together.
Tests may involve:
copying designs
matching patterns
assembling visual information
or judging spatial relationships.
These abilities can be relevant when clinicians are trying to understand the distribution of cognitive strengths and weaknesses.
Is it an intelligence test?
Some assessments include measures traditionally associated with intellectual ability.
But an epilepsy neuropsychological assessment is much broader than calculating an IQ score.
The neuropsychologist is usually more interested in the pattern.
For example:
Is memory unexpectedly weaker than reasoning?
Is verbal learning different from visual learning?
Has performance changed compared with an earlier assessment?
Do particular weaknesses fit the suspected seizure network?
A single overall number could hide these important differences.
Can someone pass or fail?
No.
There is no pass or fail mark.
Epilepsy Society explicitly advises that neuropsychological assessment is not something a person can pass or fail.
The purpose is to discover how the person's brain currently handles different kinds of information.
Trying deliberately to make the tasks look easier or harder can actually make the assessment less useful.
The best approach is simply to make a genuine effort.
What happens during the appointment?
Assessments vary considerably depending on the clinical question.
Epilepsy Society states that an assessment commonly lasts around one to three hours, although specialist surgical assessments can differ in length and organisation.
Tasks might include:
remembering lists of words
listening to and recalling stories
copying or remembering designs
naming pictures
reading
completing puzzles
answering general questions
solving problems
repeating sequences
responding quickly to particular symbols
or carrying out tasks on a computer.
Not everybody receives exactly the same tests.
Why are the tests sometimes strange or difficult?
The tasks are deliberately designed to challenge particular cognitive functions.
Some are meant to become difficult.
If everyone could complete every item easily, the test would provide little information about differences in ability.
Feeling that one section was difficult does not mean the assessment went badly.
Different people find different sections challenging.
Why are tests standardised?
Neuropsychological tests are generally standardised.
This means they have been administered to appropriate comparison groups using consistent procedures.
The neuropsychologist can then consider factors such as:
age
education
developmental history
language
and other relevant characteristics
when interpreting performance.
The purpose is not merely to count how many questions were answered correctly.
It is to understand whether the result is expected for that individual and how it compares with their performance in other cognitive areas.
Why can't an online memory test replace this?
Online cognitive tests may sometimes be interesting, but they cannot provide the same assessment.
Formal neuropsychological interpretation considers:
which exact tests were used
whether they were properly standardised
the person's history
behaviour during testing
effort
sensory or movement difficulties
language background
mood
medication
seizures
sleep
and the pattern across multiple measures.
A single online “memory score” cannot provide that level of clinical interpretation.
What if someone has difficulty reading or writing?
Tell the neuropsychology team.
Assessments can often be adapted.
Epilepsy Society advises people to tell the service about difficulties involving:
vision
hearing
or holding a pencil,
so testing can be modified where appropriate.
The psychologist should also know about:
dyslexia
developmental learning difficulties
intellectual disability
speech or language difficulties
English not being the person's first language
and other factors that may affect test performance.
The goal is to assess the person fairly.
What if someone is very tired?
Fatigue matters.
So do:
seizures shortly before assessment
severe sleep deprivation
medication changes
illness
pain
anxiety
and other temporary factors.
Tell the neuropsychologist if something unusual has happened that day.
This does not automatically mean the appointment has to be cancelled.
It gives the psychologist important context when interpreting the results.
What if a seizure happens during testing?
The assessment team should follow appropriate seizure first-aid procedures.
Testing may need to stop.
Whether it can resume depends on:
seizure type
recovery
how tired or confused the person becomes
and the purpose of the assessment.
Performance during a significant postictal period would not necessarily represent the person's usual cognitive abilities.
Medication can influence thinking
Antiseizure medicines are intended to reduce seizures, but some can cause cognitive side effects.
Possible effects can include:
drowsiness
slowed thinking
concentration difficulties
word-finding problems
or memory complaints.
Effects differ substantially between:
different medicines
different doses
combinations of medicines
and different individuals.
A neuropsychological assessment may sometimes be performed before and after a major treatment change to help identify whether cognitive function has changed.
Epilepsy Society lists investigation of possible medication side effects as one reason for neuropsychology referral.
More medicine does not automatically mean worse memory
It can be tempting to assume every cognitive problem is caused by medication.
That may be wrong.
Reducing treatment can worsen seizures, and repeated seizures may themselves affect cognitive functioning.
The clinical goal is to balance:
seizure control
medication side effects
cognition
mood
and quality of life.
Medication should not be changed simply because memory difficulties exist without discussing the problem with the epilepsy team.
Seizures themselves can interfere with memory
A seizure can disrupt memory in several ways.
Someone may:
not remember the seizure itself
lose memory for events immediately before it
remain confused afterwards
have difficulty forming memories during recovery
or experience temporary problems with concentration.
Repeated seizures may create many separate gaps.
For someone with frequent seizures, this can make everyday memory feel fragmented even when formal memory storage between seizures is relatively good.
What is postictal amnesia?
Postictal means after a seizure.
During postictal recovery, someone may temporarily be unable to:
remember what happened
recognise where they are
follow conversation
retain new information
or recall events that occurred during the recovery period.
The severity and duration vary considerably.
This is different from a stable long-term memory impairment, although both can occur in the same person.
Can seizures during sleep affect thinking the next day?
They can.
A person may not remember having a nocturnal seizure but may wake:
unusually exhausted
confused
headachy
slower mentally
or unable to concentrate normally.
Frequent epileptic activity during sleep can also disrupt normal sleep architecture.
If unexplained cognitive fluctuations repeatedly follow particular nights, this may be worth discussing with the epilepsy team.
What about epileptiform activity between seizures?
Epileptiform EEG activity can occur between obvious seizures.
This is called interictal epileptiform activity.
In some circumstances, especially particular childhood epilepsies, frequent epileptiform activity during sleep can interfere with cognitive or developmental functioning.
NICE specifically recognises poor school performance in some childhood epilepsy situations as a reason to consider neuropsychological assessment and sleep EEG.
The significance in adults depends heavily on the individual epilepsy and EEG pattern.
Mood can affect cognitive performance
Memory complaints are not always caused entirely by a structural memory-system problem.
Anxiety and depression can interfere substantially with:
concentration
motivation
information processing
sleep
and memory retrieval.
This does not mean the cognitive symptoms are imaginary.
It means cognition depends on several interacting brain systems.
A good assessment considers psychological wellbeing alongside neurological factors.
What about stress?
Stress can overload attention and working memory.
Someone who is anxious may:
repeatedly check what they are doing
become easily distracted
struggle to retrieve familiar words
or have difficulty retaining information.
If epilepsy itself is causing fear — for example fear of another seizure — stress and neurological factors may reinforce one another.
Why is sleep assessed?
Poor sleep can significantly affect:
attention
reaction time
memory
mood
and executive functioning.
People with epilepsy may have disrupted sleep because of:
nocturnal seizures
antiseizure medicines
anxiety
sleep apnoea
restless legs
or other sleep disorders.
A neuropsychologist may therefore ask about sleep rather than treating cognition as an isolated brain function.
Can neuropsychology tell where seizures begin?
Sometimes it contributes useful evidence.
Different brain systems support different cognitive abilities.
A characteristic pattern of strengths and weaknesses may be consistent with dysfunction in particular networks.
Historically, neuropsychological profiles have been used to contribute to seizure:
lateralisation
localisation
and surgical planning.
The ILAE states that presurgical neuropsychological assessment contributes collaboratively to seizure characterisation, lateralisation and localisation.
But neuropsychology does not identify seizure onset with the precision of a GPS map.
Its results must agree with the wider clinical picture.
The left brain / right brain idea is often oversimplified
It is common to hear statements such as:
“The left side is verbal memory and the right side is visual memory.”
There is some useful neurological basis behind certain patterns of hemispheric specialisation, but real brain organisation is more complicated.
Language is often more strongly represented in the left hemisphere, particularly in right-handed people, but this is not universal.
Memory involves networks across:
both temporal lobes
hippocampi
frontal systems
and many other connected brain regions.
Therefore test results cannot simply be translated into:
“Low verbal memory means left temporal epilepsy.”
They are interpreted probabilistically alongside EEG, MRI and seizure semiology.
Why is the hippocampus important?
The hippocampus is a structure deep within each temporal lobe that plays an important role in forming new memories.
Temporal-lobe epilepsy can involve hippocampal networks.
Structural abnormalities such as hippocampal sclerosis may also affect memory.
A neuropsychological assessment can help determine whether memory difficulties are consistent with dysfunction involving these systems.
Related Information Hub page:
MRI and Epilepsy: What Doctors Are Looking For
What if MRI shows hippocampal sclerosis but memory tests are normal?
That can happen.
Brain structure and cognitive performance do not always have a simple one-to-one relationship.
Possible explanations include:
functional reorganisation
relatively preserved tissue
compensation by other brain networks
individual differences
or the particular demands of the tests.
A normal cognitive score does not make the MRI finding disappear.
Likewise, significant memory impairment can exist when MRI appears normal.
This is one reason different investigations are combined.
Why is neuropsychology important before epilepsy surgery?
This is one of its major specialist roles.
Before surgery, neuropsychological assessment can help clinicians:
establish the person's cognitive abilities before surgery;
contribute information about seizure localisation and lateralisation;
estimate the risk of cognitive changes after surgery;
identify existing difficulties that may need support;
and help the person understand realistic possible outcomes.
The ILAE considers neuropsychological assessment a core part of presurgical evaluation and recommends standardised assessment of cognition together with wider behavioural and psychosocial functioning.
Why is a baseline important?
Suppose someone reports after surgery:
“My memory is worse.”
Without testing beforehand, it may be difficult to establish:
which abilities actually changed
how much they changed
or whether some difficulties already existed.
Preoperative testing creates a baseline.
The person can then be reassessed after treatment and the results compared.
The ILAE identifies establishing this baseline as one of the key functions of presurgical neuropsychology.
Can surgery affect memory?
Yes.
Any brain surgery involving networks important for memory carries a risk of cognitive change.
The exact risk depends on:
which brain region is treated
which hemisphere is involved
the amount of functioning tissue remaining
existing cognitive abilities
seizure control
age
underlying pathology
and individual brain organisation.
Epilepsy Action notes that memory and thinking can sometimes improve after surgery and can sometimes worsen; outcomes vary substantially between individuals.
This is why individual testing is more useful than a general statement such as:
“Temporal-lobe surgery damages memory.”
Could memory improve after surgery?
Yes.
There are several possible reasons.
If surgery substantially reduces or stops seizures, the brain may experience:
fewer seizures
less postictal disruption
fewer injuries
improved sleep
reduced medication burden in some cases
and less cognitive interference from uncontrolled epilepsy.
Some people therefore experience improvement in aspects of cognition or daily functioning.
Others experience decline in particular abilities.
The expected balance needs to be discussed individually.
Why might doctors worry about removing tissue that still works well?
Imagine an area of brain that produces seizures but also continues to support important memory or language functions.
Removing that tissue may reduce seizures but could also create a new cognitive difficulty.
Neuropsychological testing helps estimate whether the proposed surgical area still appears to be performing important functions.
Epilepsy Action explains that presurgical testing helps determine whether the brain region being considered for surgery performs functions that other areas may not readily take over.
Surgery is not decided by a memory test alone
Even a striking neuropsychological result is only one piece of the surgical assessment.
A multidisciplinary team may consider:
MRI
video telemetry
neuropsychology
functional MRI
PET
SPECT
MEG
psychiatric assessment
seizure semiology
and sometimes invasive EEG.
The goal is to determine:
where seizures begin
what important functions are nearby
whether the seizure-generating region can be treated safely
and what benefits and risks the individual might face.
What is functional MRI and how is it different?
Functional MRI, or fMRI, is a scanning technique used to estimate which brain areas become more active during particular tasks.
For example, someone may perform:
language tasks
finger movements
or other activities
while being scanned.
Changes in blood oxygenation provide information about which networks are active.
Neuropsychology and fMRI answer related but different questions.
Neuropsychology asks:
How well can the person perform the function?
fMRI can help ask:
Where is activity associated with that function occurring?
These results may be combined during presurgical assessment.
What is a Wada test?
Some specialist epilepsy-surgery centres may use an intracarotid amobarbital procedure, traditionally called the Wada test.
It temporarily alters function in one cerebral hemisphere so clinicians can assess language and memory contributions from each side.
It is invasive and is used much less widely than in the past because techniques such as fMRI and improved neuropsychological assessment can answer many of the same questions non-invasively.
Whether it is appropriate depends on the individual surgical case.
Not everyone undergoing epilepsy-surgery assessment will need one.
Neuropsychology after surgery
Testing does not necessarily stop once surgery is complete.
Postoperative assessment can help measure:
cognitive change
recovery
areas of improvement
emerging difficulties
and rehabilitation needs.
The ILAE emphasises that cognitive outcomes can evolve over time and recommends neuropsychological involvement in longer-term postoperative follow-up rather than thinking of outcome as a single measurement immediately after surgery.
What if surgery is not being considered?
Neuropsychological assessment can still be extremely useful.
Someone might need help because:
memory difficulties affect medication adherence
work has become harder
school performance has declined
appointments are difficult to remember
concentration is poor
or cognitive problems are reducing independence.
NICE's definition of a tertiary epilepsy service includes access to neuropsychology as a specialist assessment, not only as part of surgery.
Can neuropsychology help with everyday problems?
Yes.
The assessment should not simply produce a list of scores.
Understanding the specific difficulty can help guide practical strategies.
For example:
If attention is the main problem
Strategies might include:
reducing distractions
doing one task at a time
shorter work periods
written instructions
and regular breaks.
If prospective memory is difficult
This means remembering to do something in the future.
Strategies may include:
alarms
calendars
automatic reminders
medication apps
and placing important objects in consistent locations.
If verbal learning is difficult
Useful adaptations might include:
written information
repetition
visual supports
and breaking instructions into smaller sections.
Memory aids are not “cheating”
Glasses compensate for vision.
A calendar, alarm or notebook can compensate for unreliable memory.
External memory aids may include:
smartphone reminders
medication alarms
notebooks
whiteboards
calendars
voice notes
photographs
labelled storage
checklists
and routines.
Using them can reduce the amount of information the brain has to hold internally.
Why repetition sometimes does not work
People are often told:
“Just repeat it until you remember.”
That may help some types of learning, but not all.
If attention is the real problem, repeatedly presenting information while the person remains distracted may achieve very little.
If retrieval is the problem, recognition cues may work better.
If working memory is overloaded, information may need to be broken into smaller units.
Knowing the underlying pattern helps select strategies more intelligently.
What if someone remembers old events but cannot form new memories?
Older autobiographical memories and new learning depend partly on different processes.
A person may remember:
childhood
old jobs
family events
but repeatedly forget:
a conversation from this morning
where they put something
what happened yesterday
or information from a recent appointment.
This type of pattern can be clinically important and should be described accurately to the neuropsychologist.
What if the opposite happens?
Some people report large gaps in autobiographical memory while being able to learn ordinary new information reasonably well.
Again, there can be many possible explanations.
These may involve:
epilepsy
seizure-related amnesia
brain injury
psychological factors
sleep
medication
or other neurological conditions.
Detailed assessment can help clarify the pattern but may not always identify one simple cause.
Can epilepsy cause accelerated long-term forgetting?
Some people with epilepsy appear able to learn information normally and recall it after ordinary short test delays but lose unusually large amounts over days or weeks.
This phenomenon has been described in epilepsy research as accelerated long-term forgetting.
It has particularly been studied in some temporal-lobe epilepsies.
Standard clinical memory tests often assess recall after minutes rather than days, so such difficulties may not always be obvious on routine testing.
Research is continuing and the phenomenon should not be assumed to explain every long-term memory complaint.
What is transient epileptic amnesia?
Transient epileptic amnesia is an uncommon epilepsy syndrome in which recurrent brief episodes of amnesia are a prominent seizure manifestation.
People may retain other cognitive abilities during episodes while being unable to form or retrieve memories normally.
It usually requires specialist assessment because several other conditions can also cause transient memory loss.
A general memory complaint does not mean someone has transient epileptic amnesia.
Why might family observations matter?
People are not always aware of their own cognitive changes.
A family member may notice that someone:
repeats questions
forgets conversations
loses track of tasks
struggles with familiar routines
or has changed over time.
With the person's agreement, this information can provide useful context.
The neuropsychologist may also use questionnaires completed by the person or people close to them.
What about school and children?
Epilepsy can affect development and learning in several ways.
A child may experience problems because of:
seizures
epileptiform activity
medication
missed school
sleep disruption
learning disability
developmental conditions
or the underlying cause of the epilepsy.
A significant decline in school performance deserves attention.
In particular childhood epilepsy situations, NICE explicitly recommends considering neuropsychological assessment when school performance is poor.
Assessment may help schools understand what support the child needs rather than assuming poor performance reflects lack of effort.
Can testing identify dementia?
Neuropsychological assessment can detect patterns of cognitive decline, but epilepsy assessment is not automatically a dementia assessment.
If there is concern about progressive cognitive deterioration, clinicians may consider:
neuropsychological testing
brain imaging
blood tests
medication
mood
sleep
seizure activity
and other neurological causes.
A decline over time is different from a stable cognitive weakness that may have existed for many years.
Why is repeated testing useful?
Repeating selected tests can help determine whether cognition has:
remained stable
improved
or declined.
Examples include assessment:
before and after surgery
before and after major treatment changes
or when unexplained deterioration develops.
Because practice effects can occur — people sometimes perform better simply because they have done similar tests before — neuropsychologists account for this when interpreting change.
Does a low score prove brain damage?
No.
One unexpectedly low score can occur for many reasons.
Interpretation considers:
the whole profile
consistency across tasks
medical history
behaviour during testing
fatigue
mood
sensory difficulties
education
language
and other factors.
The important question is not whether one number is “bad”.
It is whether the overall pattern provides a coherent clinical explanation.
Does a normal assessment mean the person's memory complaints are not real?
No.
Formal testing takes place:
in a quiet environment
with one task at a time
with clear instructions
and without many of the distractions of ordinary life.
Someone may therefore perform within expected ranges during testing but still experience significant everyday difficulties when they must manage:
several conversations
medication
appointments
noise
stress
fatigue
and interruptions simultaneously.
A good assessment considers both test performance and real-world experience.
Why results may not be given immediately
Neuropsychological assessment involves much more than checking answers.
The psychologist may need to:
score tests
compare results with appropriate reference data
examine the pattern between different abilities
review medical records
consider EEG and MRI information
and prepare a clinical interpretation.
Epilepsy Society explains that results usually need analysis by a consultant neuropsychologist and are therefore not normally available immediately at the end of testing.
What might the report say?
A neuropsychological report may describe:
general intellectual functioning
attention
processing speed
language
verbal learning
visual learning
memory
executive functioning
mood
behavioural observations
relative strengths
relative weaknesses
and recommendations.
In a surgical assessment, it may also discuss:
whether findings support seizure lateralisation or localisation
cognitive risks associated with the proposed surgery
baseline abilities
and recommendations for postoperative follow-up.
The ILAE specifically identifies these functions as core elements of presurgical neuropsychology.
What should someone take to the appointment?
Useful things may include:
reading glasses
hearing aids
medication list
details of recent seizures
information about major medication changes
and anything specifically requested in the appointment letter.
If there has been:
a seizure that morning
almost no sleep
significant illness
or another unusual problem,
tell the neuropsychologist.
Questions to ask after the assessment
Useful questions include:
Which areas were strongest?
Which areas were weaker?
Is my memory problem mainly learning, storage, attention or retrieval?
Could epilepsy be contributing?
Could medication be contributing?
Could poor sleep or mood be contributing?
Does the pattern fit my MRI or EEG?
Does it suggest one brain network is more affected?
Has my cognition changed compared with previous testing?
What practical strategies would help?
Do I need workplace or educational support?
If surgery is being considered, what are my individual cognitive risks?
Will testing be repeated afterwards?
The most important message
Neuropsychological testing is not about proving whether someone is clever.
It is about understanding how their brain processes information.
Epilepsy can affect:
memory
attention
language
learning
processing speed
executive functions
and everyday cognition.
But seizures are not the only possible cause.
Medication, sleep, mood, underlying brain abnormalities and other conditions can all contribute.
Testing can help identify the pattern rather than treating every cognitive complaint as the same problem.
For people being assessed for epilepsy surgery, neuropsychology is particularly important because it helps:
establish a baseline
contribute to understanding seizure networks
predict possible cognitive risks
and support informed decisions about surgery.
For people who are not considering surgery, it can still provide something equally valuable:
a clearer explanation of why everyday thinking or memory has become difficult — and practical ways to make life easier.
Sources and further reading
NICE — Epilepsies in children, young people and adults (NG217).
NICE identifies neuropsychology as one of the specialist assessments available through tertiary epilepsy services. It also recognises circumstances in which cognitive or school-performance changes require further assessment. Last updated January 2025.
International League Against Epilepsy — Indications and expectations for neuropsychological assessment in epilepsy surgery in children and adults.
The ILAE describes neuropsychology as a core component of epilepsy-surgery assessment, including cognitive baseline measurement, contribution to localisation and lateralisation, prediction of cognitive risk and postoperative follow-up.
Epilepsy Society — Neuropsychology and neuropsychiatry.
Current UK information explaining why neuropsychological assessments are performed, what testing may involve and how results are interpreted. Updated September 2026.
Epilepsy Society — Memory and epilepsy.
Information covering epilepsy-related memory difficulties and referral for specialist memory assessment. Updated June 2026.
Epilepsy Action — Epilepsy surgery for adults.
Current information describing neuropsychological testing as part of presurgical assessment and its role in identifying memory and learning difficulties and estimating cognitive risk.
Epilepsy Action — Memory problems and epilepsy.
Current information covering memory difficulties and possible cognitive changes before and after epilepsy surgery.
Information reviewed: September 2026.
This page provides general educational information. Cognitive symptoms can have many causes and should be assessed in the context of the person's epilepsy, medication, sleep, psychological wellbeing and other health conditions.
