Understanding Memory & Cognitive Problems in Epilepsy

William B. Barr, Ph.D., ABPPChief of Neuropsychology

NYU Comprehensive Epilepsy CenterAssociate Professor of Neurology and Psychiatry,

New York University School of Medicine

Limbic SystemCerebral Cortex

BRAIN 101

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?

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

Epilepsy and Memory

Epilepsy and Memory

1. What is memory?

2. How is memory affected by epilepsy?

3. What can I do to improve memory?

Memory Processing

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

1. What is memory?

2. How is memory affected by epilepsy?

3. What can I do to improve memory?

Memory Treatment

1. Pharmacological Approaches

2. Psychological Approaches

3. Neurostimulation

Memory Treatment

Direct Pharmacological Approaches:1. Psychostimulant Medications• Developed for treatment of ADHD or Narcolepsy.• Ritalin, Provigil,

2. Acetylcholinesterase Inhibitors• Developed for treatment of dementia.• Aricept, Reminyl, Memantine

Memory Treatment

Memory Strategies

1. External Strategiesa) Environmental Manipulations

b) Notebook, Calendar, and Checklist Systems

c) Electronic Devices

2. Internal Strategiesa) Mnemonics

b) Outlining Techniques

Improving MemoryCognitive 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

Improving MemoryCognitive Enhancement

Do these programs work?

If so, which is better?

FACES StudyBrain Activation Techniques

1. Cognitive testing at baseline.2. Participants are randomly assigned to Posit Science or 3. One hour of computer training, 5 days/wk for 8 wks.4. Repeat cognitive testing at completion of trial.5. 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

1. Exercise

2. Healthy Diet

3. 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