July 21, 2026
Mayo Clinic is committed to treating not only seizures but all aspects of pediatric epilepsy. Neuropsychological testing is integrated throughout the care process to track any functional difficulties patients might experience and help evaluate them for surgery.
"Kids with epilepsy have about a 10-fold higher risk of cognitive impairment compared with unaffected children," says Eric S. Semmel, Ph.D., L.P., a clinical neuropsychologist at Mayo Clinic in Rochester, Minnesota. "National guidelines recommend neuropsychological evaluation for all children with epilepsy. But that testing is especially valuable for children who are surgical candidates. It helps us more accurately predict long-term functional outcomes and counsel families on risks and benefits of surgery."
At Mayo Clinic, neuropsychological assessments are performed in the outpatient clinic as well as alongside other inpatient diagnostic tests in the epilepsy monitoring unit. That provides convenience for families as well as an understanding of how seizure activity might affect cognitive functioning.
Mayo Clinic also offers innovative language mapping during stereoelectroencephalography. "While we're stimulating brain locations, we assess whether there is any change in certain cognitive functions compared to what the patient could do at baseline," Dr. Semmel says. "If there is, that means the brain tissue being stimulated is probably functional and that it would be best to avoid resecting it if possible."
Who should be referred
Neuropsychological assessment involves a battery of tests analyzing factors such as problem-solving ability, reasoning, learning and memory, attention, language, and visual-spatial functioning.
"It's a checkup for how different neurocognitive systems in the brain are working," Dr. Semmel says. "We integrate our test results with what we know about the child's history in order to understand individual strengths and weaknesses. We talk with the patient and the parents about how things are going and then recommend how to support the child moving forward."
Mayo Clinic recommends neuropsychological testing as early as possible after epilepsy diagnosis. "That baseline is important for understanding how epilepsy and its treatment affect a child's developmental trajectory over time," Dr. Semmel says. "Cognitive difficulties might be subtle at first. But as children grow — as expectations increase in terms of their independence and performing complex skills — children sometimes grow into those difficulties. We want to monitor that and make sure they are receiving interventions they need."
Early testing is particularly important for children with severe, early-onset epilepsy. "Unfortunately, these children can be very developmentally impacted," Dr. Semmel says. "Understanding their developmental profile allows us to recommend ways to support their learning and day-to-day functioning."
"Even kids with self-limited epilepsies have a higher rate of cognitive and learning difficulties than the general population."
Neuropsychological testing also can benefit children whose functioning doesn't align with the severity of their disease. "Some children with well-controlled seizures might still struggle in school," Dr. Semmel says. "Even kids with self-limited epilepsies have a higher rate of cognitive and learning difficulties than the general population. That's why current best practice is to perform neuropsychological testing on all children with epilepsy and then escalate services as needed."
Over time, testing helps track how children respond to treatment. "We can update our pediatric epileptologists on how a patient is functioning, which can affect decisions about changing medications or doses," Dr. Semmel says.
Neuropsychological testing is also a fundamental part of presurgical evaluation. At Mayo Clinic, neuropsychologists meet weekly with neurologists, neuroradiologists and neurosurgeons to discuss children who might be surgical candidates.
"We talk about the findings from each part of the child's evaluation, including imaging, EEG and the neuropsychological assessment, to determine whether the child is a good candidate for surgery," Dr. Semmel says.
Confirming that neuropsychological data aligns with lesions indicated by other testing is a good prognostic factor. Neuropsychological testing also facilitates personalized care.
"Based on a patient's cognitive profile and epilepsy features, we can anticipate what difficulties the child might have in the future," Dr. Semmel says. "It helps us get ahead of the ball in terms of cognitive rehabilitation — to teach the patient skills for managing cognitive weaknesses and improving quality of life."
Neuropsychological testing also benefits the patient's family. "We interface pretty closely with them, providing feedback on how the child is doing cognitively and how that might be related to the epilepsy, and how to support the child," Dr. Semmel says. "We also help counsel families on the risks and benefits of epilepsy surgery for seizure control. Controlling seizures and reducing antiseizure medications can have a very positive impact on the child's brain development."
Multidisciplinary commitment to quality of life
Mayo Clinic participates in the Pediatric Epilepsy Research Consortium, a national collaboration of physicians and researchers committed to improving pediatric epilepsy outcomes. One project Dr. Semmel is involved with includes compiling guidelines for presurgical evaluations performed by neuropsychologists who might not be epilepsy specialists. Another effort studies intraindividual variability in cognitive performance.
"The question is: Does a higher degree of variability in scores on a neuropsychological test predict other types of functional outcomes?" Dr. Semmel says. "We think intraindividual variability is particularly relevant for epilepsy because these patients have a lot of inconsistency and fluctuation in their cognitive functioning."
Collaboration among experts is the foundation of Mayo Clinic's research and clinical care. "Each discipline offers a unique lens," Dr. Semmel says. "Our multidisciplinary specialists are eager to work together. If you have a question you want answered, there's somebody at Mayo who has the expertise in the methods it would take to answer that question. It's a great environment for being able to innovate."
For more information
Refer a patient to Mayo Clinic.