Researchers at Western University have published a new feasibility study examining how to effectively assess cognition and quality of life among people living with epilepsy, including those experiencing mild or marked cognitive impairment. The work, led by Hannah G. Gray along with Karnig Kazazian, Matthew Kolisnyk, Conor J. Wild, Adrian M. Owen, and Teneille E. Gofton, appears in the journal Epilepsy & Behavior and evaluates the practicality of a computerized cognitive testing platform known as Creyos for this patient population.

Epilepsy affects approximately 50 million people worldwide, according to the World Health Organization, and frequently co-occurs with cognitive challenges that can significantly affect daily functioning and overall well-being. This study addresses a critical gap by testing whether individuals with varying degrees of cognitive impairment can reliably complete structured assessments, paving the way for better monitoring and tailored interventions in both clinical and research settings.

Understanding the Burden of Cognitive Impairment in Epilepsy

Cognitive impairment represents one of the most common comorbidities in epilepsy, affecting an estimated 70 to 80 percent of patients. Difficulties often appear in areas such as memory, attention, executive function, and processing speed. These challenges arise from multiple factors, including the underlying causes of seizures, the seizures themselves, antiseizure medications, and associated mood disorders. For many individuals, these cognitive issues exert a greater influence on daily life than seizure frequency alone.

Quality of life measures in epilepsy typically encompass physical health, psychological well-being, social relationships, and independence. When cognitive deficits are present, patients report lower scores across these domains, highlighting the need for integrated assessment approaches that capture both neurological and functional outcomes.

The Research Team and Institutional Context

The study originates from Western University in Canada, where Adrian M. Owen, a prominent neuroscientist, has long advanced understanding of consciousness and cognitive assessment through innovative tools. Hannah G. Gray, the lead author, conducted this work as part of her graduate research, building on prior investigations into seizure severity and longitudinal cognitive changes. Co-authors Karnig Kazazian, Matthew Kolisnyk, Conor J. Wild, and Teneille E. Gofton contributed expertise in neurology, neuropsychology, and clinical epilepsy care.

Access the full publication here: https://www.sciencedirect.com/science/article/pii/S1525505026002684. The team focused on drug-resistant epilepsy cases, a subgroup where cognitive concerns are especially pronounced and where new assessment methods could yield substantial clinical value.

Study Design and Methods

The feasibility study recruited participants with epilepsy who represented a spectrum of cognitive abilities, from mild impairment to more marked deficits. Researchers employed the Creyos platform, a web-based battery of cognitive tests previously validated in other populations, alongside established quality-of-life questionnaires. Key feasibility metrics included recruitment success, test completion rates, time required, participant acceptability, and any technical or fatigue-related barriers.

Participants underwent testing in controlled settings, with accommodations such as breaks or simplified instructions provided as needed. The design deliberately included individuals who might traditionally be excluded from cognitive research due to impairment severity, allowing the team to evaluate real-world applicability.

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Key Findings on Feasibility and Outcomes

Results demonstrated strong feasibility. A high proportion of participants across impairment levels successfully completed the Creyos battery, with acceptable completion times and positive feedback on usability. Preliminary data revealed expected patterns of cognitive performance, with greater variability and lower scores in those with marked impairment, while quality-of-life scores correlated with both seizure characteristics and cognitive metrics.

These outcomes suggest that computerized tools like Creyos can be adapted for broader use in epilepsy clinics and research protocols, reducing reliance on lengthy in-person neuropsychological evaluations that may not be accessible everywhere. The study also identified minor adjustments, such as optimized test sequencing, that could further enhance tolerability.

Implications for Clinical Practice and Research

Integrating routine cognitive and quality-of-life assessments into epilepsy care could improve treatment planning, rehabilitation referrals, and patient counseling. For university-based researchers, the findings support expanded use of digital tools in multicenter studies, potentially accelerating discoveries in neuromodulation, medication optimization, and non-pharmacological interventions.

Academic institutions may see increased demand for interdisciplinary training programs that combine neurology, neuropsychology, and data science. This aligns with growing emphasis on patient-centered outcomes in grant applications and clinical trials.

Broader Context: Global Epilepsy Research Landscape

Worldwide efforts to address epilepsy comorbidities continue to expand. The World Health Organization emphasizes that up to 70 percent of people with epilepsy could achieve seizure freedom with proper diagnosis and treatment, yet cognitive and psychosocial support often lag. Studies from diverse regions, including low-resource settings, consistently show elevated rates of depression, memory complaints, and reduced social participation linked to cognitive difficulties.

This Canadian-led feasibility work complements international initiatives by validating accessible digital methods that could scale across different healthcare systems. Future collaborations between universities in high-income and resource-limited countries could leverage similar platforms to collect comparable data.

Future Directions and Opportunities for Academics

Building on these results, larger validation studies are warranted to establish normative data specific to epilepsy subtypes and to explore longitudinal tracking. Integration with neuroimaging, genetic profiling, and wearable seizure monitors represents a promising frontier. Researchers interested in contributing to this field may explore positions in cognitive neuroscience laboratories or epilepsy centers.

University administrators evaluating research portfolios will note the alignment with funding priorities around digital health, precision medicine, and chronic disease management. PhD candidates and postdoctoral fellows can position themselves competitively by gaining experience with computerized testing platforms and mixed-methods approaches that combine quantitative cognition scores with qualitative patient perspectives.

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Stakeholder Perspectives and Practical Takeaways

Clinicians welcome tools that fit into busy outpatient workflows without excessive time demands. Patients and caregivers appreciate assessments that feel relevant to daily challenges rather than abstract laboratory tasks. Advocacy organizations focused on epilepsy highlight the importance of reducing diagnostic and management disparities, particularly for those with co-occurring intellectual or developmental disabilities.

Actionable steps for institutions include piloting Creyos or similar batteries in neurology departments, training research assistants on standardized administration, and incorporating quality-of-life metrics into electronic health records. Such steps support both improved patient care and richer datasets for academic inquiry.