Epilepsy and Memory Mary Lou Smith Department of Psychology University of Toronto at Mississauga Hospital 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”. Epilepsy n = 760 Non epilepsy n = 146 Asked respondents to comment on the frequency of 18 everyday memory failures How frequently do you forget where you have put things? Losing things around the house? How freuently do you have to go back to check if you have done something you meant to do? How frequently do you find a word on the tip-of-your-tongue, you know what it is but cannot find it? Rate freqency ranging from “not at all in the last 3 months” to “more than once a day” Rate the nuisance arising from their memory difficulties.

Frequency of Everyday Memory Failures Epilepsy n = 760 Non epilepsy n = 146 Asked respondents to comment on the frequency of 18 everyday memory failures How frequently do you forget where you have put things? Losing things around the house? How freuently do you have to go back to check if you have done something you meant to do? How frequently do you find a word on the tip-of-your-tongue, you know what it is but cannot find it? Rate freqentyc ranging from “not at all in the last 3 months” to “more than once a day” Rate the nuisance arising from their memory difficulties. Thompson & Corcoran, 1992

Rating of Nuisance Arising From Their Memory Difficulty 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

to repeat it to me over and over so finally I would get it “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 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 AEDs produce global changes in the excitation levels in the brain and often lead to cognitive and behavioural deficits Deficits vary and must be considered independently in every patient A number of consistent risk factors have been established Polypharmacy High blood levels Elderly are more susceptible to AED side effects because of pharmacokinetic and pharmacodynamic reasons

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

What to do? Optimize physical health Optimize mental 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