1. Epilepsy and Memory Mary Lou Smith Department of Psychology
University of Toronto at Mississauga
Hospital for Sick Children

2. Goals To review: Memory problems in epilepsy
Adults
Children
Factors that contribute to memory problems
Strategies for dealing with a poor memory

3. 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

4. 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.

5. 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

6. Rating of Nuisance Arising From Their Memory Difficulty
Thompson & Corcoran, 1992

7. Daily Rating of Memory Failure
Underestimation of the frequency of memory failures
We forget how much we forget!

8. What about children? 42 children with intractable epilepsy
70% self-reported memory problems
Smith, Elliott & Lach, 2006

9. 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

10. 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

11. The Extent of the Problem: Example of Story Recall
Smith, Elliott & Lach, 2002

12. What are the kinds of memory problems that people report?

13. 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

14. 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

15. 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

16. 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

17. Autobiographical Information
Lah et al., 2006

18. Remote Memory
Lah et al., 2006

19. What contributes to the memory problems?
Biologic factors – related to causes and nature of seizures
Psychological factors

20. 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

22. 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

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

24. What to do? Optimize physical health Optimize mental health
Nutrition, sleep, exercise
Optimize mental health
Deal with stress

25. 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

26. 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: