The current state of cognitive rehabilitation for individuals with epilepsy and pathways for improvement: a multinational cross-sectional survey of epilepsy specialists

Seizure. 2025 Apr 18;130:4-10. doi: 10.1016/j.seizure.2025.04.008. Online ahead of print.

ABSTRACT

OBJECTIVE: Despite the relevance of psychosocial and cognitive issues for people with epilepsy (PWE), there remains scarce data on cognitive rehabilitation programs as a central care pathway alongside pharmacological and surgical treatment in epilepsy. We aimed to map the use, availability and characteristics of rehabilitation programs for epilepsy across different countries worldwide.

METHODS: We conducted a web-based survey of epilepsy specialists practicing in different countries around the world. Participants were asked to provide information on the availability, accessibility, use and methodology of cognitive rehabilitation in their country of practice.

RESULTS: One hundred and ten responses were received across 66 different countries: 45 respondents were from Europe, 35 – from Latin America, 14 – from the Eastern Mediterranean region, 7 – from Asia and Oceania, 8 – from Africa and 1 – from North America. Most participants were neurologists and/or epileptologists (96, 87 %) practicing in university hospitals (69, 63 %) and caring for adult patients (85, 77 %). Any rehabilitation measures for PWE were reported as generally available by 75 (68 %) respondents. For cognitive rehabilitation, this was reported by 40 (36 %) specialists with an average service accessibility of 5.4 ± 2.5 out of 10. When available, cognitive rehabilitation is primarily used in patients with cognitive complaints (38, 81 %), mood complaints or comorbid psychiatric disorders (27, 57 %). While individual sessions predominate (29, 62 %), cognitive rehabilitation programs are heterogeneous in form – compensatory (10, 21 %), restitution (12, 26 %) techniques, internal (12, 26 %) and external (12, 26 %) strategies are used alongside psychoeducation (15, 32 %) and psychological counselling (16, 34 %) without clear predominance of either approach. In 13 (32.5 %) cases, cognitive rehabilitation was supported by national standards of practice or state legislature.

CONCLUSIONS: Cognitive rehabilitation programs for PWE are generally less available than other forms of rehabilitation across the world. New evidence-based procedure development and harmonization is required to promote establishment and effective use of these services.

PMID:40319522 | DOI:10.1016/j.seizure.2025.04.008