William B. Barr, Ph.D., ABPP

Limbic System Cerebral Cortex BRAIN 101

Cognitive & Behavioral Impairment in Epilepsy

Epilepsy and Behavior Cognitive Disorders Intellectual FunctioningIntellectual Functioning Attention and VigilanceAttention and Vigilance Executive FunctionsExecutive Functions LanguageLanguage Visuospatial SkillsVisuospatial Skills Learning and Memory**Learning and Memory**

Attention and Concentration Arousal and alertnessArousal and alertness Span of attentionSpan of attention Processing speedProcessing speed VigilanceVigilance Sustained attentionSustained attention

Executive Functions InitiationInitiation Response InhibitionResponse Inhibition Set ShiftingSet Shifting Concept FormationConcept Formation SequencingSequencing Organization & PlanningOrganization & Planning Insight & AwarenessInsight & Awareness

Language Expressive SpeechExpressive Speech RepetitionRepetition Auditory ComprehensionAuditory Comprehension NamingNaming ReadingReading WritingWriting Higher Conceptual FunctionsHigher Conceptual Functions

Epilepsy and Memory 1. What is memory? 2. How is memory affected by epilepsy? 3. What can I do to improve memory? 1. What is memory? 2. How is memory affected by epilepsy? 3. What can I do to improve memory?

Study of 55 patients with temporal lobe epilepsy: Difficulties with memory reported in 77.4%.Difficulties with memory reported in 77.4%. Reports of being “extremely bothered” by their memory disturbance in 13.2%.Reports of being “extremely bothered” by their memory disturbance in 13.2%. Over half (50.9%) feel that “seizures interfere with my memory”.Over half (50.9%) feel that “seizures interfere with my memory”. Data presented at the AES Meeting, 2003 Epilepsy and Memory

Most Common Memory Complaints Questionnaire completed by 55 subjects: I forget a phone number if I don’t copy it down right away (47.3%).I forget a phone number if I don’t copy it down right away (47.3%). A word goes on the “tip of my tongue” but I can’t get it out (43.7%)A word goes on the “tip of my tongue” but I can’t get it out (43.7%) I have trouble with remembering names of people I met last week (41.8%).I have trouble with remembering names of people I met last week (41.8%). I talk to somebody on the phone and don’t remember it minutes later (34.5%)I talk to somebody on the phone and don’t remember it minutes later (34.5%) I forget what someone said to me a half an hour ago (30.9%).I forget what someone said to me a half an hour ago (30.9%). Data presented at the AES Meeting, 2003 Epilepsy and Memory

1. What is memory? 2. How is memory affected by epilepsy? 3. What can I do to improve memory?

Memory Processing

Epilepsy and Memory 1. What is memory? 2. How is memory affected by epilepsy? 3. What can I do to improve memory?

Epilepsy and Memory 1. What is memory? 2. How is memory affected by epilepsy? 3. What can I do to improve memory?

Memory Treatment 1.Pharmacological Approaches 2.Psychological Approaches 3.Neurostimulation

Memory Treatment Direct Pharmacological Approaches: 1.Psychostimulant Medications Developed for treatment of ADHD or Narcolepsy. Developed for treatment of ADHD or Narcolepsy. Ritalin, Provigil, Ritalin, Provigil, 2.Acetylcholinesterase Inhibitors Developed for treatment of dementia. Developed for treatment of dementia. Aricept, Reminyl, Memantine Aricept, Reminyl, Memantine

Memory Treatment

Memory Strategies 1.External Strategies a)Environmental Manipulations b)Notebook, Calendar, and Checklist Systems c)Electronic Devices 2.Internal Strategies a)Mnemonics b)Outlining Techniques

Improving Memory Cognitive Enhancement Techniques 1.Cognitive enhancement is the improvement or strengthening of mental skills including attention, memory, processing speed, and problem solving. 2.Cognitive enhancement programs or ‘brain-training’ interventions can target any of these core cognitive skills. 3.Usually, repetition of targeted activities is involved with the assumption that doing so will improve targeted cognitive domains and improve general mental faculties by enhancing neural connections and networks. From Jak, Seelye, & Jurik, 2013

Improving Memory Cognitive Enhancement Do these programs work? If so, which is better?

FACES Study Brain Activation Techniques 1.Cognitive testing at baseline. 2.Participants are randomly assigned to Posit Science or 3.One hour of computer training, 5 days/wk for 8 wks. 4.Repeat cognitive testing at completion of trial. 5.Programs provided to participants at no cost.

Improving Memory Indirect Methods Epilepsy - Control Seizures - Minimize Number of Medications Depression/Anxiety - Pharmacological Management - Psychotherapy - Stress Reduction Other Medical Conditions

Improving Memory Indirect Methods 1.Exercise 2.Healthy Diet 3.Good Sleep Habits

FACES Study Brain Activation Techniques Investigators: Stella Karantzoulis, Ph.D. William B. Barr, Ph.D. Steven Pacia, M.D. To see if you qualify, call: