Presentation on theme: "Epilepsy and Memory Mary Lou Smith Department of Psychology University of Toronto at Mississauga Hospital for Sick Children."— Presentation transcript:
Epilepsy and Memory Mary Lou Smith Department of Psychology University of Toronto at Mississauga Hospital 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 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
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 Smith, Elliott & Lach, 2002
What are the kinds of memory problems that people report?
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