Mapping neuropsychological care in pediatric epilepsy: a national survey by the Italian chapter of the international league against epilepsy (LICE)

Background and purpose Neuropsychological assessment is essential in pediatric epilepsy care, yet its implementation in clinical practice remains insufficiently characterized. This study describes neuropsychological practices across Italian pediatric epilepsy centers. Methods A national, cross-sectional, online survey was conducted between December 2024 and March 2025 by the Italian League Against Epilepsy. The 59-item survey assessed professional profiles, clinical practices, use of technology, and training needs. Eligible participants were psychologists and neuropsychologists involved in pediatric epilepsy care. Results Twenty-three centers completed the survey (response rate 59.0%). Assessment was systematically integrated within multidisciplinary teams across diagnostic, treatment, and follow-up phases. Primary referral drivers were cognitive concerns, treatment effects, and neuropsychiatric comorbidities. Core cognitive domains were consistently assessed, though test selection varied substantially: most centers used flexible approaches, whereas 43.5% implemented standardized protocols. Screening for intellectual disability, attention-deficit/hyperactivity disorder, and learning disorders was widely applied, while severe intellectual disability evaluations relied primarily on qualitative methods. Tele-neuropsychology was used selectively for follow-up rather than primary evaluation. Conclusions This study provides the first comprehensive national mapping of pediatric epilepsy neuropsychology practices. Neuropsychological assessment is a well-established component of pediatric epilepsy care in Italy, broadly consistent with international recommendations. However, variability in organization and assessment practices highlights the need for harmonized protocols, increased resources, and specialized training. Multidisciplinary and flexible models, alongside the cautious integration of digital tools, may enhance care and improve long-term outcomes