1. Karen Blackmon, Ph.D.

2. Cognitive & Behavioral Impairment in Epilepsy

3. Epilepsy and Behavior Cognitive Disorders Intellectual FunctioningIntellectual Functioning AttentionAttention Working MemoryWorking Memory Executive FunctionsExecutive Functions LanguageLanguage Visuospatial SkillsVisuospatial Skills Learning and MemoryLearning and Memory

4. Epilepsy and Behavior Cognitive Disorders Intellectual FunctioningIntellectual Functioning AttentionAttention Working MemoryWorking Memory Executive FunctionsExecutive Functions LanguageLanguage Visuospatial SkillsVisuospatial Skills Learning and MemoryLearning and Memory

6. Attention The ability to direct focus Ignoring distractions Sustaining focus for long periods of time

8. Attention The ability to direct focus Ignoring distractions Sustaining focus for long periods of time As many as 40-60% of children with epilepsy have attention problems.

9. Working Memory Working memory provides an active workspace for information Executive functions perform operations on this information in service to goals. The executive system determines the best strategy to reach a goal from a set of alternatives held in working memory.

10. Executive Functions Executive functions are skills that regulate our thinking and behavior.Executive functions are skills that regulate our thinking and behavior. Guide problem-solving and decision- making.Guide problem-solving and decision- making. Control emotional responses and social behaviorControl emotional responses and social behavior

11. Executive Functions EXECUTIVE SYSTEM INITIATION RESPONSE INHIBITION PROBLEM SOLVING SET SHIFTING CONCEPT FORMATION SEQUENCING INSIGHT

12. How are Executive Functions Assessed? What are the main problems that interfere with your daily functioning? What are the goals? work/college/school? Do symptoms interfere with achieving these goals? How do your abilities compare with others of the same age and background? How are you and your family coping? What kind of rehabilitation strategies might be helpful? Neuropsychological Assessment

13. How are Executive Functions Assessed? EXECUTIVE SYSTEM INITIATION Name as many words as you can that start with the letter P….

14. How are Executive Functions Assessed? EXECUTIVE SYSTEM RESPONSE INHIBITION

15. How are Executive Functions Assessed? EXECUTIVE SYSTEM SET SHIFTINGSEQUENCING

16. How are Executive Functions Assessed? EXECUTIVE SYSTEM PROBLEM SOLVING CONCEPT FORMATION

17. How are Executive Functions Assessed? EXECUTIVE SYSTEM INSIGHT

18. Executive Dysfunction Difficulties with initiating, organizing and carrying out activitiesDifficulties with initiating, organizing and carrying out activities –Loss of 'get up and go‘ –Problems with thinking ahead and carrying out the sequence of steps needed to complete a task This can often be mistaken for 'laziness' or a lack of motivation and energy.

19. Executive Dysfunction Rigidity in thoughts and actionsRigidity in thoughts and actions Difficulty in evaluating the result of actionsDifficulty in evaluating the result of actions Reduced ability to change behavior or switch between tasks if neededReduced ability to change behavior or switch between tasks if needed

20. Executive Dysfunction Poor problem solving –Difficulty conceptualizing all aspects of the problem –Finding it hard to anticipate consequences –Decreased ability to make accurate judgments or find solutions if things are going wrong. Well, lemme think…You’ve stumped me son. Most people only wanna know how to go the other way.

21. Executive Dysfunction Impulsivity –Acting too quickly and impulsively without fully thinking through the consequences. Spending more money than you can afford Taking unnecessary risks Overeating Having trouble sticking to a daily schedule Blurting things out, just because

22. Executive Dysfunction Mood Disturbance –Difficulty in controlling emotions which may lead to outbursts of anger or crying. –Rapid mood changes, such as switching from happiness to sadness for no apparent reason.

23. Executive Dysfunction Difficulties in social situations –Reduced ability to engage in social interactions. –Finding it hard to initiate, participate in, or pay attention in conversations. –Poor judgment in social situations, which may lead to saying or doing inappropriate things.

24. Executive Functions Executive functions rely on the integrity of the frontal lobesExecutive functions rely on the integrity of the frontal lobes

25. Executive Functions Frontal lobes develop slowly through childhood Frontal lobes develop slowly through childhood

26. Executive Functions Frontal lobes continue to develop into adulthood Frontal lobes continue to develop into adulthood

27. Executive Functions Frontal lobes are thinner in temporal lobe epilepsy compared to controlsFrontal lobes are thinner in temporal lobe epilepsy compared to controls (Lin et al., 2007)

28. Strategies for Supporting Executive Functions Complete important work in a quiet, distraction-free placeComplete important work in a quiet, distraction-free place Give yourself well-timed rest breaks after long periods of concentrationGive yourself well-timed rest breaks after long periods of concentration Have set start and stop times for workHave set start and stop times for work Increase the structure in your environment and follow routinesIncrease the structure in your environment and follow routines

29. Strategies for Supporting Executive Functions Break big projects down into smaller parts and do a little bit at a timeBreak big projects down into smaller parts and do a little bit at a time Apply organization strategies (e.g. making lists, outlines) to structure your work habitsApply organization strategies (e.g. making lists, outlines) to structure your work habits Give yourself extra time to get things doneGive yourself extra time to get things done Avoid multi-taskingAvoid multi-tasking

30. Strategies for Supporting Emotional Functioning Keep a daily log of your mood statesKeep a daily log of your mood states Track the relationship between your mood and:Track the relationship between your mood and: SleepSleep Time of dayTime of day WorkloadWorkload Know your triggers!Know your triggers! Call upon a set of personal coping strategies that reliably lift your moodCall upon a set of personal coping strategies that reliably lift your mood music, long walks, pets, meditation, yogamusic, long walks, pets, meditation, yoga Observe the effects of social media. Does it leave you feeling better or worse?Observe the effects of social media. Does it leave you feeling better or worse?

31. Strategies for Supporting Emotional Functions If you feel unable to manage your emotions, call your physician.If you feel unable to manage your emotions, call your physician. medicationsmedications Individual psychotherapyIndividual psychotherapy group therapygroup therapy Remind others to make allowances for the difficulties you may experience in controlling your mood. Loved ones should know that emotional changes are a common side effect of epilepsy.Remind others to make allowances for the difficulties you may experience in controlling your mood. Loved ones should know that emotional changes are a common side effect of epilepsy. When you feel very upset, it may be better to leave the situation in the short term and come back to it later.When you feel very upset, it may be better to leave the situation in the short term and come back to it later.

32. Strategies for Supporting Social Functioning Ask trusted friends or family members to remind you of the most appropriate thing to do or say if you are struggling in social situations.Ask trusted friends or family members to remind you of the most appropriate thing to do or say if you are struggling in social situations. Mentally prepare for social situationsMentally prepare for social situations Try to remember similar past scenarios and what went wrong (or right?)Try to remember similar past scenarios and what went wrong (or right?) Visualize social interactions beforehandVisualize social interactions beforehand Check in with people to gauge their reaction to things you say or do:Check in with people to gauge their reaction to things you say or do: What do you think?What do you think? How did that sound?How did that sound? How did that make you feel?How did that make you feel?

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

34. FACES Study tDCS for Memory Difficulty in TLE Investigator: Anli A. Liu, M.D. To see if you qualify, call: 646-558-0876