To review the historical, conceptual, and ethical foundations of intelligence testing in neuropsychology and to consider whether alternative cognitive performance labels offer greater conceptual precision while reducing stigma.

We conducted a narrative review of early twentieth century cognitive assessments, tracing the evolution of intelligence testing and its intersections with eugenic ideology. Key examples include the Army Alpha and Beta tests administered during World War I and Ellis Island immigration assessments, which were frequently interpreted without consideration of cultural or educational influences. We examine how these practices informed early interpretations of neuropsychological performance, particularly in individuals with epilepsy, and shaped initial characterizations of neurologically based cognitive abilities.

Early intelligence testing was grounded in the belief that intelligence was a fixed and directly genetically determined trait. Test performance was interpreted as an index of biological superiority, lending scientific legitimacy to eugenic ideologies and reinforcing stigma toward individuals with epilepsy. Although modern frameworks emphasize multidimensional cognitive abilities, intelligence-based characterization persists and continues to be frequently reported as a primary outcome of neuropsychological testing.

In contexts that require a single summary indicator of cognitive performance, labels such as Total Cognitive Composite are recommended since they avoid implying a fixed or unitary capacity. Continued reliance on the construct of “intelligence” is inconsistent with contemporary models of cognition, reflects outdated theoretical assumptions, and carries enduring psychosocial stigma. Moreover, its circular and internally inconsistent definitions substantially limit its validity and appropriateness within contemporary adult clinical neuropsychological practice.

Highly purified cannabidiol (CBD) represents a novel anti-seizure medication (ASM) with established efficacy in specific epilepsy syndromes; however, real-world evidence across diverse etiologies remains limited. Following Health Canada approval in November 2023, CBD provides an additional option for treatment-resistant seizures. This study describes early real-world experience with CBD within a Provincial Comprehensive Epilepsy Program during its inaugural year of availability in Canada.

A retrospective chart review examined all pediatric patients prescribed CBD between June 2024 and April 2025.

Sixty-one patients (median age 10.5 years) were included. Prior to CBD initiation, patients had trialed a median of eight ASMs and were receiving a median of three concomitant ASMs. Fifteen patients had prior CBD exposure, including nine who transitioned directly to the highly purified formulation. Diagnoses comprised Lennox–Gastaut syndrome (38%), Dravet syndrome (11%), other developmental and epileptic encephalopathies (39%) and focal/multifocal epilepsy (11%). After a median treatment duration of 172 days, 22% of patients achieved ≥50% seizure reduction, including 7% who became seizure-free, while 30% experienced a 25%–49% reduction. Forty-eight percent demonstrated ≤25% seizure reduction, and 11% experienced seizure exacerbation. Despite variable seizure outcomes, 70% continued CBD therapy, frequently attributable to benefits transcending seizure frequency, including diminished seizure severity, increased seizure-free intervals, improved behavior and enhanced sleep quality. Adverse effects occurred in 30% of patients, prompting treatment discontinuation in 6.5%.

This real-world analysis suggests that CBD may be effective and well tolerated in children with highly refractory epilepsy across heterogeneous etiologies, with potential benefits beyond seizure control.

Due to the high prevalence of depression and anxiety in people with epilepsy, the International League Against Epilepsy Commission on the Neuropsychiatric Aspects of Epilepsy recommends implementing routine screening for depression and anxiety symptoms. Our epilepsy group began administering three screening questionnaires to all clinic patients in 2016: the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Beck Anxiety Inventory (BAI) and the Generalized Anxiety Disorder-7 (GAD-7).

We aim to review our experience with this screening approach.

We reviewed 2253 sets of questionnaires completed from January 2018 to March 2020 and studied the actions taken by epileptologists in response to a positive screening.

Thirty-six percent of all assessed patients screened positive on at least one questionnaire: 13.6% screened positive for depression symptoms (NDDI-E ≥ 16), 12.3% for anxiety symptoms (BAI ≥ 22) and 30.3% for GAD symptoms (GAD-7 > 7). Among patients with a positive screening, 36% received a care intervention, 59% did not and 5% declined the neurologist’s recommendation. Among patients for whom an intervention was implemented, 58% were referred to a mental health professional (generally a neuropsychiatrist), 29% had their antiseizure medication adjusted to alleviate their symptoms and 13% received another intervention.

In our clinic, an important proportion of patients screened positive for depression and/or anxiety symptoms. Fewer than half received a management option to alleviate their symptoms. We conclude that while routine screening increases the detection of depression and anxiety among epilepsy patients, it must be accompanied by effective interventions and access to mental-health professionals.

People living with epilepsy (PWE) experience higher rates of depression compared with the general population. Depression in PWE is associated with increased seizure burden and reduced quality of life. We aimed to examine clinical and demographic correlates of depression severity using the nine-item Patient Health Questionnaire in PWE experiencing negative health events in the past 6 months.

1. (a) To assess how depressive severity correlated with seizure frequency;

2. (b) To examine how outcomes such as quality of life are influenced by depressive severity;

3. (c) To investigate how demographic factors affect depressive severity.

Depressive severity was defined as a score of 0–9 for no depression to mild symptoms (NMD), 10–19 for moderate depression (MOD) and 20–27 for severe depression. Continuous variables were analysed using the Kruskal–Wallis equality-of-populations rank test, and categorical variables were compared using Fisher’s exact test. Baseline data were taken from Sequential, Multiple Assignment Randomized Trial no. NCT04705441.

The sample of 159 participants had a mean age of 39.46 years (s.d., 12.15), with the majority (n = 131, 82.4%) identifying as White. A total of 48% (n = 76) of participants met the criteria for NMD, 41% (n = 65) met those for MOD and 11% (n = 18) met those for severe depression. The severe depression group had significantly more seizures in the past 30 days, as well as greater perceived stigma, lower social support and lower quality of life, compared with the other groups. Race was found to correlate with depressive severity in NMD and MOD versus the severe depression group.

Among adults with epilepsy, depressive severity was positively correlated with seizure frequency and stigma and negatively correlated with quality of life, social support and overall functioning. These results highlight the importance of routine screening for depression, and of providing management of these symptoms in comprehensive epilepsy care.

Cenobamate is a novel anti-seizure medication (ASM) in the alkyl carbamate family with a dual mechanism of action: targeting persistent sodium currents and positively modulating γ-aminobutyric acid type A receptors independent of benzodiazepines. Approved by Health Canada in June 2023, it offers an additional treatment option for seizures. This study’s objective was to review the real-world experience with cenobamate in a Provincial Comprehensive Epilepsy Program, soon after its availability in Canada.

A retrospective study of all patients prescribed cenobamate from June 2023 to May 2025.

The study population comprised 36 patients with a median age of 18 years (range: 8–23 years). Seizure etiology was structural (n = 18) and genetic (n = 13). Prior to starting cenobamate, patients had tried a mean of 10 ASMs. Additionally, 19 (53%) had undergone epilepsy surgery, 3 (8%) had failed the ketogenic diet and 11 (31%) were treated with neuromodulation. Following a mean duration of 10.5 months of treatment with cenobamate, 50% (18/36) had a > 50% seizure reduction, and 20% (7/36) had a 25%–50% reduction of seizures. Fourteen percent (5/38) of patients were seizure-free at the most recent follow-up. The median dose was 200 mg (range: 62.5–400 mg). Eighteen patients (50%) experienced adverse effects (AEs), including dizziness, drowsiness, nausea and vomiting. However, only two patients discontinued cenobamate due to AEs. No patients discontinued cenobamate due to a lack of efficacy.

This real-world study demonstrates the efficacy and tolerability of cenobamate in patients with highly drug-resistant epilepsy

Epilepsy is frequently accompanied by psychiatric symptoms, including mood disturbances such as depression, irritability and euphoria. Interictal dysphoric disorder (IDD), characterised by depressive and affective symptoms, is typically managed with psychiatric treatment. However, persistent symptoms, despite adequate psychiatric intervention, may indicate an underlying epileptogenic mechanism.

To highlight the importance of recognising epileptogenic contributions to persistent psychiatric symptoms, even in patients with apparently well-controlled epilepsy.

We present a case report of a Japanese woman in her 40s with well-controlled epilepsy; however, she developed enduring psychiatric symptoms. Clinical features, psychiatric treatments, neurological evaluation and therapeutic outcomes are described.

The patient experienced anxiety, depression, irritability and fear, leading to an initial diagnosis of IDD. Treatment with escitalopram and olanzapine achieved only partial symptom relief. Residual symptoms prompted further investigation, which revealed symptoms suggestive of temporal lobe epilepsy auras. Adjustment of anti-seizure therapy with lacosamide resulted in complete resolution of psychiatric symptoms, marked functional recovery and a reduction in her Hamilton Depression Rating Scale (HAMD-17) score improved from 23 to 6.

This case highlights that even in apparently well-controlled epilepsy persistent psychiatric symptoms may indicate an underlying epileptogenic mechanism rather than a primary psychiatric disorder. Careful evaluation and appropriate optimisation of anti-seizure medication can yield substantial psychiatric and functional improvements, underscoring the importance of multidisciplinary assessment in such presentations.

The prevalence of psychiatric disorders in people with epilepsy is as high as 43% and, among them, psychoses represent a severe comorbidity.

This is a narrative review discussing the interplay between epilepsy and psychosis and identifying challenges in diagnosing and managing psychotic symptoms in epilepsy, focusing on the past 10 years.

Articles published between June 2014 and December 2024 were identified through searches in PubMed using the search terms ‘psychosis’, ’seizure, epilepsy and convulsion’, ‘epile*’, ’seizure*’ and ‘convuls*’.

The association between epilepsy and psychosis was shown to be bidirectional, with people with psychosis being at increased risk of epilepsy. In epilepsy, psychotic symptoms may occur in three clinical scenarios, with clinical presentation and management varying in relationship to these: seizure-related (peri-ictal), treatment-related or independent of the former.

There are no guidelines for the management of psychotic symptoms in epilepsy, but it is possible to apply policies for the treatment of psychoses, taking into account the peculiarities and needs of people with epilepsy.