The landscape of cognition and behaviour in the epilepsies: from neuropsychology to lived experience

Abstract Neurobehavioral research in epilepsy has evolved into a broad, multidisciplinary field spanning the full human lifespan. Despite substantial progress, however, its conceptual organization remains unclear. We propose a unifying framework—a “landscape”—that defines the field’s structure and clarifies relationships among its major clinical and research domains. Rooted empirically in neuropsychology, but expanding to encompass the wider neurobehavioral dimensions of epilepsy, this framework adopts a lifespan perspective and organizes the field into six dimensions: (1) clinical cognitive domains, (2) memory disorders and syndromes, (3) complex neurocognition, (4) mental health, (5) co-occurring lifespan disorders, and (6) lived experience. We show that the study of cognition and behavior in epilepsy has expanded far beyond its classical foundations into a broader, inherently interdisciplinary enterprise. This expansion has been orderly and hierarchically meaningful, progressing from core cognitive functions to increasingly complex neurobehavioral phenomena. For each dimension, we delineate central themes, principal lines of inquiry, methodological approaches, key findings, and critical gaps. This framework extends beyond description and situates the field’s historical structure–function foundations within a contemporary network-based account of epilepsy and its neurobehavioral manifestations. The six dimensions are conceptualized not as discrete silos but as interrelated, and potentially hierarchically organized, systems of inquiry. Cross-cutting challenges include limited standardization of assessments, inadequate characterization of heterogeneity and latent subgroups, and insufficient attention to transdiagnostic processes that distinguish epilepsy-specific features from those shared across chronic conditions. An especially critical imbalance is evident: the emphasis on risk and impairment has well outpaced investigation of resilience and adaptation, constraining understanding of protective factors and pathways to health and well-being. By situating these six dimensions within a coherent conceptual landscape, this framework provides a foundation for integrating traditionally isolated areas of inquiry and advancing a lifespan, network-informed, and transdisciplinary account of neurobehavioral phenotyping in epilepsy.