Neuropsychological assessment in adult epilepsy: rationale, test selection, and clinical integration across non-surgical care in Italian patients

To provide a practical framework for neuropsychological assessment in adult epilepsy, specifying what each measure evaluates and how results can support clinical decisions regarding epileptic patients. This work is a clinically oriented narrative review and expert proposal for non-surgical adult epilepsy care in Italian settings. Test selection was guided by domains repeatedly emphasized in epilepsy neuropsychology, by their practical relevance to routine clinical decision-making, by compatibility with major international recommendations, and by the availability of Italian adaptations or normative data. For each test, we describe the primary construct assessed and the specific epilepsy-related clinical question it may help address. Structured cognitive exams can be sensitive to lateralization and localization, medication-related cognitive effects, and comorbid mood and anxiety symptoms. When integrated with electroencephalography and structural imaging, these profiles support clinical interpretation and guide counseling. Serial assessment can also inform medical management, rehabilitation planning, and quality-of-life interventions. The expanded framework clarifies which patients should be referred for assessment, why epilepsy must be conceptualized as a heterogeneous group of syndromes and network disorders, where neuropsychological data may support but not replace differential diagnosis, and how current ILAE recommendations contextualize the proposed battery. Neuropsychological assessment is a core component of comprehensive epilepsy care, but its clinical value is greatest when the battery is tailored to the referral question, syndrome, disease stage, treatment context, and patient priorities. The proposed battery should be read as a structured, adaptable framework for routine adult non-surgical practice, rather than as a rigid battery to be applied uniformly across patients.