1. William B. Barr, Ph.D., ABPP Annual FACES Epilepsy ConferenceAnnual FACES Epilepsy Conference April 27, 2014April 27, 2014

2. Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

3. What is memory? Cognitive Disorders Intellectual FunctioningIntellectual Functioning Attention and VigilanceAttention and Vigilance Executive FunctionsExecutive Functions LanguageLanguage Visuospatial SkillsVisuospatial Skills Memory**Memory**

4. Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

5. What is Memory? Types of memory Processing

6. What is Memory? Structure of Long-Term Memory (LTM)

7. What is Poor Memory? What is Poor Memory? Brodaty et al., 2002

8. What causes poor memory? What causes poor memory?

9. Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

10. Limbic System Cerebral Cortex BRAIN 101

11. 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 How is memory affected by epilepsy?

12. Questionnaire completed by 55 subjects with focal epilepsy: 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 someone on the phone and don’t remember minutes later (34.5%)I talk to someone on the phone and don’t remember 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 How is memory affected by epilepsy? The most common memory complaints in patients with epilepsy

13. Cognitive & Behavioral Impairment in Epilepsy

14. Antiepileptic Drugs (AEDs)

15. Treating memory impairment in patients with epilepsy Step Number One Optimize Medications: - Control seizures - Minimize number of AEDs - Use AEDs with least potential side effects Address Other Medical & Psychiatric Conditions: - Mood disorder, anxiety, or stress - Blood pressure, high cholesterol, etc.

16. Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

17. Neuropsychological Exam Interview Review of Medical Records Neuropsychological Testing Self-Report Inventories Report Feedback

18. The Normal Curve

19. Neuropsychological Test Battery Intellectual FunctioningIntellectual Functioning Attention and VigilanceAttention and Vigilance Executive FunctionsExecutive Functions LanguageLanguage Visuospatial SkillsVisuospatial Skills Memory**Memory** Self-Report QuestionnairesSelf-Report Questionnaires

20. Memory Testing Verbal Memory -Word Lists -Word Pairs -Narrative Passages Visual Memory -Designs & Figures -Unfamiliar Faces Remote Memory -Public Episodic Knowledge -Autobiographical Memory

21. Learn These Words Ballet Ice Cream Pie Penguin Zebra Play Goat Opera Cupcake

22. Remember These Figures

23. 1. Tell me the words from the list. Free Recall 2. Draw those figures for me.

24. Recognition Pie Cabinet Zebra Play Lake

25. Semantic Organization 1.Animals: Penguin, Zebra, Goat 2. Entertainment: Play, Opera, Ballet 3. Deserts: Pie, Cupcake, Ice Cream

26. Visual Memory Encoding

27. Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

28. Treating memory impairment in patients with epilepsy Step Number Two

29. Memory Treatment 1.Biological approaches 1.Psychological approaches 2.Lifestyle approaches

30. Memory Treatment Biological approaches  Psychopharmacology  Neurostimulation

31. Memory Treatment Pharmacological Approaches (Alzheimer’s disease) Pharmacological Approaches (Alzheimer’s disease)

32. Memory Treatment

33. Neurostimulation Neurostimulation a.Transcranial Magnetic Stimulation (TMS) b.Transcranial Direct Current Stimulation (tDCS) Dayan, 2013, Nature Neuroscience

34. Memory Treatment Psychological approaches  Cognitive remediation  Personal mnemonics  Brain activation techniques

35. Cognitive Rehabilitation Major Strategies Major Strategies 1.External a)Environmental Manipulations b)Notebook, Calendar, and Checklist Systems c)Electronic Devices 2.Internal a)Mnemonics b)Bizarre imagery

36. A. Education Enhancing awareness of nature and severity of memory disturbance Enhancing awareness of nature and severity of memory disturbance Learning that others have the same types of problems Learning that others have the same types of problems Teaching meta-memory skills Teaching meta-memory skills B. Training in Use of Mnemonic Strategies Visualization Visualization Association A. Education Enhancing awareness of nature and severity of memory disturbance Enhancing awareness of nature and severity of memory disturbance Learning that others have the same types of problems Learning that others have the same types of problems Teaching meta-memory skills Teaching meta-memory skills B. Training in Use of Mnemonic Strategies Visualization Visualization Association Cognitive Rehabilitation Memory rehabilitation groups Memory rehabilitation groups

38. 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

39. Improving Memory Cognitive Enhancement Techniques

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

42. Memory Treatment Lifestyle approaches  Nutrition  Exercise  Relaxation strategies  Sleep

43. Memory Treatment Lifestyle Approaches Lifestyle Approaches

44. Memory Treatment Lifestyle Approaches Lifestyle Approaches

45. Memory Treatment Nutritional Supplements Nutritional Supplements

46. Memory Treatment Lifestyle Approaches Lifestyle Approaches

47. Memory Treatment Lifestyle Approaches Lifestyle Approaches Sleep and Consolidation

48. Memory Improvement

49. William B. Barr, Ph.D., ABPP NYU Comprehensive Epilepsy Center Departments of Neurology & Psychiatry NYU School of Medicine Phone: 646-558-0809 email: william.barr@nyumc.orgwilliam.barr@nyumc.org Twitter: @WB_BARR Contact Info: