Epilepsy and Memory

Mary Lou SmithDepartment of Psychology

University of Toronto at MississaugaHospital for Sick Children

Goals

• To review:– Memory problems in epilepsy

• Adults• Children

– Factors that contribute to memory problems

– Strategies for dealing with a poor memory

Acknowledgements and Cautions

• Contributions of Irene Elliott and Dr. Suncica Lah

• Great variability / individual differences in experiences of memory difficulties– Most likely to apply in more severe

epilepsy

Memory

One of most common complaints of adults with epilepsy

Thompson and Corcoran, 1992“Everyday memory failures in people

with epilepsy”.

Frequency of Everyday Memory Failures

0

15

30

45

Per

cen

t

Tip-of-tongue Going back to check Forgetting where things are Forgetting names

Epilepsy

Non epilepsy

Thompson & Corcoran, 1992

Rating of Nuisance Arising From Their Memory Difficulty

0

15

30

45

Per

cen

t

Moderate Serious

Epilepsy

Nonepilepsy

Thompson & Corcoran, 1992

Daily Rating of Memory Failure

• Underestimation of the frequency of memory failures

• We forget how much we forget!

What about children?

42 children with intractable epilepsy

70% self-reported memory problems

Smith, Elliott & Lach, 2006

“My memory … I forget

things ... The teacher has

to repeat it to me over and

over so finally I would get it

and remember it … they have to teach

the same thing tomorrow so I wouldn’t

forget it.” [12 year old boy]

Acknowledgement: Irene Elliott

Quality of Life in Pediatric Epilepsy(Arunkumar et al., 2000)

Parents• AED side effects Cognitive effects• Future• Injury• Independence• Brain damage• Dependence• + others

Children• Social problems Cognitive effects• Driving• Sports restrictions• AED side effects• School• Dependence• + others

The Extent of the Problem:Example of Story Recall

0

10

20

30

40

50

60

Normal Mild-Moderate

Severe

Range of Performance(Epilepsy Group)

Per

cen

t0

20

40

60

80

100

120

Epilepsy(n=51)

NormalPopulation

Smith, Elliott & Lach, 2002

What are the kinds of memory problems that people report?

Retention of learned material

“A lot of times when I’m talking I will know what I’m going to say to you and then for some odd reason I’ll tell you the first part of the story and then I just forgot the second part and that would be the important part. I won’t remember it for a long time or I’ll go home and go ‘that’s what it was’… so that drives me insane”.

Smith, Elliott & Lach, 2006

Short-term / working memory

“…my short-term memory is very bad…if my mom tells me to do a chore in the house or something and she leaves, I’ll forget…unless she writes it down on a paper”.

Smith, Elliott & Lach, 2006

Word retrieval (semantic memory)

“I can’t just spit out a word, a proper word. I know what I’m want to explain to you but I can’t think of a proper word and I know the word and I’m so used to the word and it could be the easiest word. I can’t get it out. I’ll have to wait and it’ll make me really aggravated”.

Smith, Elliott & Lach, 2006

Autobiographical memory

“I don’t remember any of my childhood… because of these seizures I don’t remember a lot of my life… I can get bits and pieces but not anything really… it’s not very good ... I’m not happy about it”.

Smith, Elliott & Lach, 2006

Autobiographical Information

Lah et al., 2006

Remote Memory

Lah et al., 2006

What contributes to the memory problems?

• Biologic factors – related to causes and nature of seizures

• Psychological factors

Biologic Factors

Seizure type and etiology Neuropathology - Structural cerebral

damage Age at seizure onset Seizure frequency Seizure duration Seizure severity Interictal dysfunction Part of the brain affected by seizures

Medications

Anti-epileptic drugs produce global changes in the excitation levels in the brain

Effects vary and must be considered independently in every patient Number of AEDs Blood levels Age

Psychosocial Factors

Psychiatric and psychological morbidity may contribute to memory problems Depression Anxiety Psychosis Attention-deficit disorder

What to do?

Optimize physical health Nutrition, sleep, exercise

Optimize mental health

Deal with stress

Strategies

• Pay attention and concentrate

• Repeat, repeat, repeat

• Make it meaningful

• Organize information while you are learning it

• Use external memory aids

• Organize your environment and keep a regular routine

Special Considerations for Children

• Keep in mind the child’s age– Young children need a lot of external support– As they get older, can introduce strategies for them

to implement on their own

• Work with the school

• Recognize that variability is typical

• Strategies for learning: www.ldonline.org