Neuropsychology

Clinical Care

Neuropsychological services are integrated with the many clinical and experimental Neurosurgical programs, and include the entire developmental span from infancy to diseases associated with aging. Although the main focus of clinical care is neurosurgical, neuropsychological services are also provided to patients in general neurology, pediatrics, and trauma.

The Epilepsy Surgery Program (ESP) serves as a model for how neuropsychological services are integrated into the comprehensive care and treatment planning. During Phase I, a comprehensive multidisciplinary evaluation is obtained. Neuropsychological examination determines baseline levels of functioning, facilitates localization of seizure onset, and ascertains the risk of surgical morbidity with respect to cognitive functioning. This information is integrated with data obtained from other clinical evaluations at phase 1 (e.g., scalp recording of ictal onset, video monitoring of seizure semiology, structural imaging studies including volumetric analysis, and functional imaging studies) to identify surgical candidates, and enhance treatment for nonsurgical candidates. During Phase II, the Intracarotid Amytal Procedure (IAP, or Wada test) is performed to determine hemispheric speech dominance, determine memory capacity of each hemisphere, and provide additional convergent evidence of localization of seizure onset.

Cortical stimulation for functional mapping during phase III (i.e., invasive electrophysiological recording) determines the precise location of sensory, motor and language cortex. Cortical stimulation and neuropsychological assessment during Phase IV (surgery) allows for more precise assessment of language function in the surgical field. Post-operative cognitive examinations facilitate the provision of rehabilitative and psychotherapeutic services and re-integration to the community.

Pediatric neuropsychology provides a broad base of assessment services to children with neurological disease or injury. The recognition that the evolving nervous system responds to injury, illness, and treatment in different ways than the mature brain underlies the philosophy of the Pediatric Neuropsychology Service. Consultations are provided to all medical services treating children at Yale, with special programs including children with epilepsy, pediatric neuro-oncology, Spina Bifida, hydrocephalus, a broad spectrum of genetic and developmental disorders, infectious disorders (e.g., HIV, meningitis, encephalitis, CNS Lyme), and disorders of learning and attention.

The neuropsychology faculty also collaborates with the faculty of other departments and sections to deliver services to patients who are not managed primarily by neurosurgery. Consultations are provided to all patients who may benefit from neuropsychological services, including Neurology, Trauma, Geriatrics, Psychiatry, Cardiology, Internal Medicine, and Pediatrics.