The COVID-19 pandemic altered virtually every facet of health care. Nonemergency procedures were postponed to preserve hospital bed capacity, routine health care was often deferred, cumbersome patient and provider screening procedures were implemented, and telemedicine was embraced to reduce the exposure risk for both patients and health care workers.
The presurgical neuropsychological evaluation of children with drug-resistant epilepsy is particularly challenging under these conditions. The standard test instruments have only been validated for in-person use, and we cannot assume that remotely administered tests are equally valid. Environmental distractions are more difficult to control when the patient is at home. Cooperation with testing is improved by establishing rapport with the patient and family, but this is more difficult with remote testing. The remote examiner could also miss subtle clues about the child’s effort level or understanding the task at hand.
Nancy Nussbaum, PhD, and her colleagues at Dell Medical School explored these pandemic-related challenges as they related to pediatric patients with drug-resistant epilepsy, analyzing evidence-based methods of virtual evaluation to develop a systematic decision-making process for remote neuropsychology. In this article they provide several scenarios to guide the use of virtual neuropsychological assessment and discuss the potential pitfalls of remote testing. The need for remote test validation remains, of course, but in the meantime, the models presented here may be useful for other multidisciplinary surgical teams who need to utilize remote neuropsychological testing.
Nussbaum NL, Young SR, DeLeon RC, Engelmann ML, Schraegle WA. The future is now: pediatric neuropsychological presurgical epilepsy evaluation in the age of COVID-19. Epileptic Disord 2021;23:274-280.