Understanding Memory & Cognitive Problems in Epilepsy

Understanding Memory & Cognitive Problems in Epilepsy William B. Barr, Ph.D., ABPP Chief of Neuropsychology NYU Comprehensive Epilepsy Center Associate Professor of Neurology and Psychiatry, New York University School of Medicine

BRAIN 101 Cerebral Cortex Limbic System

Cognitive & Behavioral Impairment in Epilepsy

Epilepsy and BehaviorCognitive Disorders • Intellectual Functioning • Attention and Vigilance • Executive Functions • Language • Visuospatial Skills • Learning and Memory**

Attention and Concentration • Arousal and alertness • Span of attention • Processing speed • Vigilance • Sustained attention

Executive Functions • Initiation • Response Inhibition • Set Shifting • Concept Formation • Sequencing • Organization & Planning • Insight & Awareness

Language • Expressive Speech • Repetition • Auditory Comprehension • Naming • Reading • Writing • Higher Conceptual Functions

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 Study of 55 patients with temporal lobe epilepsy: • Difficulties with memory reported in 77.4%. • Reports of being “extremely bothered” by their memory disturbance in 13.2%. • 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%). • 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 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%). Data presented at the AES Meeting, 2003

Memory Processing

Memory Treatment • Pharmacological Approaches • Psychological Approaches • Neurostimulation

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

Memory Treatment

Memory Strategies • External Strategies • Environmental Manipulations • Notebook, Calendar, and Checklist Systems • Electronic Devices • Internal Strategies • Mnemonics • Outlining Techniques

Improving MemoryCognitive Enhancement Techniques Cognitive enhancement is the improvement or strengthening of mental skills including attention, memory, processing speed, and problem solving. Cognitive enhancement programs or ‘brain-training’ interventions can target any of these core cognitive skills. 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 MemoryCognitive Enhancement Do these programs work? If so, which is better?

FACES StudyBrain Activation Techniques Cognitive testing at baseline. Participants are randomly assigned to Posit Science or One hour of computer training, 5 days/wkfor 8 wks. Repeat cognitive testing at completion of trial. Programs provided to participants at no cost.

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

Improving MemoryIndirect Methods • Exercise • Healthy Diet • Good Sleep Habits

FACES StudyBrain Activation Techniques Investigators: Stella Karantzoulis, Ph.D. William B. Barr, Ph.D. Steven Pacia, M.D. To see if you qualify, call: 646-558-0950

Understanding Memory & Cognitive Problems in Epilepsy