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Epilepsy and Memory. Mary Lou Smith Department of Psychology University of Toronto at Mississauga Hospital for Sick Children. To review: Memory problems in epilepsy Adults Children Factors that contribute to memory problems Strategies for dealing with a poor memory. Goals.
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Epilepsy and Memory Mary Lou Smith Department of Psychology University of Toronto at Mississauga Hospital for Sick Children
To review: Memory problems in epilepsy Adults Children Factors that contribute to memory problems Strategies for dealing with a poor memory Goals
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 Acknowledgements and Cautions
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 Thompson & Corcoran, 1992
Rating of Nuisance Arising From Their Memory Difficulty 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
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 Quality of Life in Pediatric Epilepsy(Arunkumar et al., 2000)
The Extent of the Problem:Example of Story Recall Smith, Elliott & Lach, 2002
Autobiographical Information Lah et al., 2006
Remote Memory Lah et al., 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
