Optimising the role of neuropsychology and developing an individualised approach to neurocognitive risk in stereo-EEG

Stereo-EEG can provide a pathway to surgical resection for patients with drug-resistant epilepsy. Despite widespread use, there remains variability in practices and a paucity of research evaluating neuropsychological outcomes. As a first step to establishing clinical guidelines, an international survey of clinicians supported characterisation of areas of consistency versus variability. Prospective neuropsychological examination of stereo-EEG patients demonstrated while stereo-EEG guided radiofrequency thermocoagulation is cognitively safe for most, there is a subset of patients at increased risk of experiencing a decline in memory or language. These findings have direct clinical implications for individualised counselling to avoid unanticipated deficits and improve outcomes.