Epilepsy and Memory
Mary Lou SmithDepartment of Psychology
University of Toronto at MississaugaHospital 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”.
Frequency of Everyday Memory Failures
0
15
30
45
Per
cen
t
Tip-of-tongue Going back to check Forgetting where things are Forgetting names
Epilepsy
Non epilepsy
Thompson & Corcoran, 1992
Rating of Nuisance Arising From Their Memory Difficulty
0
15
30
45
Per
cen
t
Moderate Serious
Epilepsy
Nonepilepsy
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
“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
0
10
20
30
40
50
60
Normal Mild-Moderate
Severe
Range of Performance(Epilepsy Group)
Per
cen
t0
20
40
60
80
100
120
Epilepsy(n=51)
NormalPopulation
Smith, Elliott & Lach, 2002
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
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
Psychosocial Factors
Psychiatric and psychological morbidity may contribute to memory problems Depression Anxiety Psychosis Attention-deficit disorder
What to do?
Optimize physical 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