The neuropsychological presentation of women with epilepsy: clinical considerations and future directions

Abstract

Objective: Cognitive, mood, and behavioral changes are common among persons with epilepsy (PWE), resulting in a complex neuropsychological presentation. Women with epilepsy (WWE) represent a distinct cohort within the broader epilepsy population due to sex and gender-specific factors impacting epilepsy semiology and treatment. However, unique neuropsychological profiles among WWE have not been established. This narrative review aims to further define neuropsychological correlates in WWE and promote meaningful discussion related to enhancing the provision of neuropsychological care within this clinical population. Method: Current literature in PWE examining differences in cognitive function, mental health, and quality of life (QoL) between women and men was critically reviewed, emphasizing considerations for neuropsychological practice. Results: WWE demonstrate a preservation of verbal learning and memory compared to men both pre- and post-surgically, with sex-based, neurobiological mechanisms likely contributing to this association. WWE also have elevated risk for affective disorder psychopathology, suicidality, and traumatic experiences. Epidemiology related to psychotic and bipolar spectrum disorders is less clear, and findings are mixed regarding sex-specific behavioral side effects of antiseizure and psychotropic medication. Finally, hormonal and obstetric factors are highlighted as important contributors to neuropsychological symptoms in WWE, with elevated risk for low QoL and increased stigma associated with greater medical and psychiatric comorbidities compared to men. Conclusions: While emerging literature has begun to characterize the neuropsychological presentation of WWE, future research is needed to define sex and gender differences in neuropsychological sequalae among PWE to ensure consistency and quality of care for WWE.

Keywords:

• Epilepsy
• women
• neuropsychology
• gender differences
• cognition

Disclosure statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Notes

1 While the terms “sex” and “gender” are often erroneously used interchangeably, a consensus among biomedical and sociological literature suggests that these terms have similar but distinct meanings. That is, “sex” refers to biological and phenotypic features that are genetically mediated and determined by sex chromosomes whereas “gender” refers to individual characteristics based on social constructs (National Institutes of Health Office of Research on Women’s Health, 2023). The current review conceptualizes findings related to neuropsychological phenomena in PWE with these definitions in mind in the spirit of using clear and consistent language throughout.

Additional information

Funding

The authors do not have any funding to report for this project.