The Role of a Neuropsychologist in Epilepsy Care | Dr. Sue Hayman-Abello and Dr. Jennifer Fogarty
March is #EpilepsyMonth and #PurpleDay, dedicated to raising awareness about epilepsy. We’re highlighting the pivotal role of neuropsychology in evidence-based, best-practice epilepsy care through the ECHO Epilepsy knowledge translation model. We’re proud to profile two leading clinical neuropsychologists who drive our Advanced Program for Epilepsy in Adults: Dr. Sue Hayman-Abello, PhD., C. Psych., from the Epilepsy Monitoring Unit (EMU) at London Health Sciences Centre, and Dr. Jennifer Fogarty, PhD., C. Psych., from the Neuroscience Ambulatory Clinic Epilepsy Program at Hamilton General Hospital.
Dr. Sue Hayman-Abello
What population do you work with (children, youth, or adult) and what’s a key challenge/reward that you experience in this profession?
I work with adults who have epilepsy, ranging from late teens to seniors. As neuropsychologists, we attempt to understand the current picture of cognition, behaviour, and mood for a person at one particular timepoint. Our conclusions are made possible only by also identifying and incorporating relevant developmental, medical, educational, social, emotional, and systems variables from birth and childhood forward.
It can be challenging to forge a complete picture, incorporating the many factors that influence a person’s current neuropsychological functioning but integrating information from multiple sources and time points across the lifespan is like solving a puzzle, which can be deeply satisfying.
How did you become involved with the ECHO Epilepsy Program and what drew you to want to participate?
Within the LHSC Adult Epilepsy programme, we work as a closely knit team of dedicated and collaborative health professionals, who have amassed a great deal of specialized knowledge over the years. Our main purpose is to serve the patients who come through our doors, but by sharing knowledge with other interested health professionals it broadens the number of people in Ontario who can be diagnosed and treated locally, perhaps avoiding a future visit to our specialized centre. It feels good when we share what we might consider to be ‘standard’ information within our realm, only to find that it is received by ECHO attendees as novel and quite helpful.
How do you collaborate with other healthcare professionals in the management of epilepsy, and what impact does this collaboration have on patient outcomes?
One of the aspects of our Epilepsy programme that I enjoy the most is the teamwork we have built within our Epilepsy Monitoring Unit staff. From EEG Technologists to Nurses to PSWs to Psychologists and Neuropsychologists to Psychometrists to Social Workers to Physicians, and all of our respective students and trainees, we work together, every day, to provide accurate patient assessment and treatment during what can be a busy and dynamic admission.
Arranging an accurate, efficient, and meaningful Neuropsychological evaluation, amidst a competing goal of provoking and analyzing seizures, depends on multiple conversations with each of these health professionals on a daily basis, whether it is about the timing and logistics of testing, or sharing acute clinical concerns and patient observations between caring professionals. It takes a village.
Can you share a memorable case where neuropsychological assessment significantly influenced the treatment plan for a patient with epilepsy?
When people with epilepsy have reached the stage of being considered for surgical treatment, there are many variables to consider. In some cases, the semiology, electrophysiological findings, imaging and other diagnostic tests have all lined up such that a specific surgery might have a reasonable potential to reduce or eliminate seizures. The results of the neuropsychology assessment can provide additional, sometimes crucial, information about the neuropsychological risks of a proposed surgical plan and/or about the whole person more broadly. For example, some patients have specific cognitive profiles, life experiences or treatment expectations illuminated by the neuropsychological evaluation that indicate a need for more pre-surgical testing, change the direction of the treatment offered, or we learn that they might not want surgery at all. Providing this additional information and perspective helps the team and patient decide next steps together, from a well rounded position.
Dr. Jennifer Fogarty
What population do you work with (children, youth, or adult) and what’s a key challenge/reward that you experience in this profession?
I work with adults. A key challenge is that many of the patients I see have had aspects of their life disrupted by their epilepsy. It can be rewarding to help patients to understand their cognitive difficulties and to help them to learn to cope with these difficulties.
How did you become involved with the ECHO Epilepsy Program and what drew you to want to participate?
I became involved with the ECHO Epilepsy Program when I first began working in the Epilepsy Program at the Hamilton General Hospital in April 2021. The multi-disciplinary nature of the sessions drew me to want to participate as the topics are highly relevant to my work. The sessions are also highly collegial, which helps to promote learning.
How do you collaborate with other healthcare professionals in the management of epilepsy, and what impact does this collaboration have on patient outcomes?
I regularly collaborate with our program’s social worker, nurse practitioner and physicians as well as neuropsychology at other sites in Canada (London and Montreal). This helps to ensure that patients have the best possible outcome. This might include optimizing their medication dosages to reduce side effects, helping to access appropriate supports in their home community or helping to ensure appropriate surgical recommendations.
In your experience, what are the most common misconceptions about epilepsy that you encounter, and how do you address them in your practice?
One of the most common misconceptions is that patients with epilepsy cannot have a decent quality of life. I address this by collaboration with our multi-disciplinary team and by helping our patients access supports through Epilepsy South Central Ontario.
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