Cet article constitue une revue du bilan neuropsychologique associé aux épilepsies partielles pharmaco-résistantes. Les rôles de l’évaluation neuropsychologique ainsi que les circonstances particulières associées à l’examen des épilepsies partielles sont décrits dans une première section. En général, les épilepsies partielles pharmaco-résistantes affectent les processus attentionnels ce qui, en contrepartie, entraîne des difficultés dans un ensemble de fonctions intellectuelles. La pharmacothérapie, spécialement la polythérapie, diminue également les ressources attentionnelles. Les épilepsies du lobe temporal affectent peu le rendement intellectuel mais elles entraînent des difficultés de mémoire généralement plus grandes que celles observées suite à d’autres types d’épilepsies partielles. Les données les plus récentes remettent toutefois en question la notion voulant que l’épilepsie temporale gauche soit associée à des déficits de mémoire verbale et que réciproquement, l’épilepsie temporale droite n’affecte que la mémoire visuo-perceptive. L’épilepsie frontale, quant à elle, entraîne des déficits de coordination motrice et de contrôle de l’inhibition. Elle peut en outre, affecter les fonctions dites exécutives et la mémoire de travail, mais il semble que ces atteintes soient plus importantes chez l’enfant que chez l’adulte. Idéalement, le bilan neuropsychologique devrait permettre de cibler des interventions auprès des réseaux social, professionnel et académique et faciliter l’intégration et le mieux-être du patient.

The neuropsychological assessment is an essential part of the clinical work-up of patients suffering from pharmaco-resistant epilepsy. The aim of the present article is to give an overview of the assessment with regard to the functions tested, the techniques employed and the factors influencing the interpretation of the results. In the first part of the article, the role of the neuropsychological evaluation is discussed in relation to other methods of clinical investigation, such as EEG, brain imaging techniques and sodium amytal exploration, all of which intend to identify the localization (region and laterality) of the epileptogenic focus. This is particularly important for patients slated for epilepsy surgery. In addition, the neuropsychological exam aims to determine the extent of the deficits in various cognitive and sensori-motor domains by taking into account the structural and/or functional reorganization that may have taken place and the compensatory mechanisms that are available to the patient. In this context, the effect of various factors influencing the mental and emotional functioning of the patient, such as the age at onset and duration of the epilepsy, the presence of a structural lesion, the type and number of anticonvulsant drugs, the personality and the adaptability of the patient must be considered. In children, the effect of recurrent seizures may be more devastating since these risk to interfere with normal brain development. On the other hand, the greater plasticity of the immature brain provides a larger window in which compensation can take place. Evidence suggests that attentional processes are affected in all types of epilepsy. Furthermore, the antiepileptic medication may have a deleterious effect on the cognitive and emotional status of the patient, particularly in patients with pharmaco-resistant epilepsy who are usually taking a combination of anticonvulsant drugs. The second part of the article presents localization-specific neuropsychological impairments and the tests most suited to reveal these deficits. Thus, in temporal lobe epilepsy, memory functions are more affected than in other types of partial epilepsy, whereas intellectual functions are usually preserved. However, recent studies cast some doubt on the prevailing view that left-hemisphere foci are associated with verbal memory deficits only and that right-hemisphere foci solely affect visuo-spatial memory. The dichotomy appears to be more subtle, especially in patients with a long-standing seizure history. Frontal foci produce deficits in motor coordination, attention, working memory and executive functions. These deficits appear to be more pronounced in children than in adults. Few studies have explored the neuropsychological consequences of parieto-occipital foci given that this type of epilepsy is relatively rare. The neuropsychological profile of the patient should guide healthcare providers to implement the necessary remedial measures to facilitate the patient’s social integration and to improve his quality of life.