Feasibility of direct-to-home teleneuropsychological evaluations in US Veterans with functional seizures

Abstract: Introduction: Functional seizures (FS) present with cognitive dysfunction that impacts quality of life, suggesting that neuropsychological evaluations would be beneficial. However, these patients often face barriers to in-person appointments, leading to a gap in care. The current study objective is to examine aspects of feasibility of direct-to-home (DtH) teleneuropsychology for patients with FS. Method: U.S. Veterans with FS were prospectively recruited from a national VA program from October 2023 to February 2025. Participants completed DtH cognitive testing and neurological/mental health assessments. We measured satisfaction with teleneuropsychology using an adapted questionnaire. We implemented a Seizure Safety Protocol to direct management of acute events. Descriptive analyses report on relevant feasibility metrics. Results: Of 60 referrals, 22 participants (37%) consented. Of those 22 participants, 20 (91%) completed the full study. Two of 22 (9%) participants were discontinued partway through data collection due to prolonged symptoms following a seizure. Five participants experienced 11 total seizures during the study, but these events did not appear to impact the validity of test data, with a few exceptions (11/720 [<2%] missing cognitive test indices). Satisfaction with the telehealth study was high such that 20/22 (91%) participants agreed or strongly agreed that they were satisfied with the study overall. Participants reported enjoying the convenience, safety, and comfort of the DtH method, although some preferred traditional in-person sessions. Conclusions: Findings support the use of teleneuropsychology in FS. A Seizure Safety Protocol can provide guidance on handling presumed medical emergencies and can mitigate risk of invalid cognitive data. Neuropsychologists may consider declining to use telehealth if seizures are common and likely to lead to (i) the request for acute medical care and/or (ii) prolonged symptoms that interfere with the assessment. More widespread use of teleneuropsychology for patients with FS in the future may improve access to beneficial clinical services.