Examining the Effectiveness of Neuropsychological Interventions on Cognition in Patients with Epilepsy: A Systematic Review and Meta-Analysis.

Abstract

This meta-analysis evaluated the effectiveness of neuropsychological interventions in enhancing cognition in patients with epilepsy. The systematic review was conducted under PRISMA guidelines. Of 1363 articles, 25 met the inclusion criteria. Meta-analyses assessing pre-post changes in experimental interventions (i.e., without comparison to control groups) revealed moderate effects on cognition in adults (g = 0.29; 95% CI = 0.18, 0.40; p < 0.0001), with significant effects for attention (g = 0.24; 95% CI = 0.06, 0.43; p = 0.0098), immediate memory (g = 0.34; 95% CI = 0.21, 0.47; p < 0.0001), delayed memory (g = 0.38; 95% CI = 0.18, 0.57; p < 0.0001), and language (g = 0.33; 95% CI = 0.06, 0.59; p = 0.0159). In pediatric samples, moderate effects were found on overall cognition (g = 0.55; 95% CI = 0.22, 0.89; p = 0.0012), with gains in attention (g = 0.66; 95% CI = 0.15, 1.17; p = 0.01) and working memory (g = 0.80; 95% CI = -0.05, 1.65; p = 0.06). Comparisons with control groups (i.e., patients without intervention) showed a trend towards positive effects in adults (g = 0.35; 95% CI = -0.00, 0.71; p = 0.053), with brain training games associated with poorer outcomes (B = -1.03; SE = 0.52; 95% CI = -2.05, -0.00; p = 0.049). No significant differences were found in pediatric samples (g = 0.34; 95% CI = -0.22, 0.89; p = 0.24). The findings support the implementation of targeted cognitive interventions in clinical practice, offering evidence-based recommendations.