Do cognitive activities during neuropsychological testing trigger seizures?

Objective: Previous studies have suggested that stress precipitates seizures and that cognitive exertion may increase brain excitability, thereby possibly contributing to seizure occurrence during neuropsychological examinations. The present study investigates whether specific, standardized cognitive activities are linked to seizure occurrence.

Methods: Two thousand neuropsychological examinations including the Verbal Learning and Memory Test (VLMT) and Diagnosticum für Cerebralschädigung-Revised (DCS-R) were retrospectively evaluated, and occurrence of seizures during neuropsychological testing was assessed. In addition, patient characteristics and epilepsy features were collected from electronic patient charts. Statistical analysis was performed using chi-squared test and linear mixed regression models.

Results: Data of 1444 patients (age = 46 ± 17 years, 48% female) were included in the study, of whom 95% displayed focal epilepsy. Seizures occurred in 36 (1.8%) of 2000 neuropsychological examinations in 34 (2.4%) of the 1444 patients. Test-related seizures were observed only in patients with focal epilepsy, predominantly during memory tests (58%) and most frequently during VLMT (33.3%) and DCS-R (19.4%). A significant association was found between seizure occurrence during VLMT and a seizure onset zone in the right and left temporal lobe, whereas no such association was identified with seizures occurring during DCS-R. No other features were linked with seizure occurrence during testing.

Significance: The occurrence of seizures during neuropsychological examinations is very rare. Our data do not support the notion that specific cognitive activities favor acute onset of seizures but rather suggest a coincidental relationship.