Epilepsy and Memory… | October 21, 2018

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To say that lack of memory is a major worry for those of us with epilepsy is hardly a surprise.

In fact, it’s the number one concern.

Simply put, memory is our brain’s ability to store information and find it again later.

Chemical and electrical changes happen in your brain when new memories are made.

It’s a natural brain process that requires continuing attention and recording by parts of your brain.

Seizures interfere with your memory by interfering with attention or input of information.

Confusion often follows a seizure, and during this foggy time, new memory traces aren’t being laid down in the brain.

Tonic-clonic (grand mal) seizures in which you lose consciousness can interfere with normal brain processes and disrupt the registration phase of short-term memory.

Sometimes longer term memories from the period prior to the seizure are lost as well, since these memories may have not yet being fully integrated into your brain’s memory system.

There are many different ways to classify how memory works.

Some people rely more on their verbal memory, remembering in terms of words or sounds, while others use their visual memory, relying on pictures or spatial relationships.

This can be for lots of reasons, including the type of seizures you have, the effects of medication, the effect of concentration or mood, lack of sleep, age, or the effect of epilepsy surgery.

Common everyday memory problems include:

  1. Being unable to come up with a word that we feel is “on the tip of our tongue”, apparently because of a verbal memory processing problem.
  2. Having to go back to check to see if something was done, such as turning off the stove, probably reflecting a failure to pay adequate attention at the time.
  3. Forgetting where we put something, probably a visual-spatial memory process problem.
  4. A verbal malfunction, where you know the words or names, but just can’t come up with them.
  5. Not remembering what has been said or been told is another.

The types of problems people have vary, and how serious a nuisance the problems are varies from person to person as well.

Any type of epileptic seizure could potentially affect your memory, either during or after a seizure.

If you have lots of seizures, memory problems might happen more often.

Some people have generalized seizures that affect all of the brain.

Others have focal seizures (sometimes called partial seizures) that affect only part of the brain.

Some people have both generalized and focal seizures.

If you have focal seizures, the way your seizures can affect your memory will depend on where in the brain your seizures happen.

The brain has two halves called hemispheres.

Each half has four parts called lobes: the occipital, parietal, temporal and frontal lobes.

Abnormalities in the temporal or frontal lobes of the brain are the most common reason for memory problems.

The left temporal lobe is important for verbal memories such as learning names and remembering facts for exams.

If you have seizures that start in this area, you may have problems remembering words, and get stuck mid-sentence.

The right temporal lobe is important for visual memories like remembering a person’s face or finding your way around a place.

The frontal lobe is important for prospective memory. Seizures in this area can cause problems remembering to do things in the future.

You may have difficulty remembering information straight after a seizure.

This is sometimes called post-ictal (after-seizure) confusion and it usually goes away once you have recovered.

If you have temporal lobe epilepsy you may have memory difficulties even if your seizures are well controlled.

That’s because the temporal lobe is responsible for creating memories.

Memory problems can sometimes happen due to the side-effects of anti-epileptic drugs (AEDs).

Drowsiness or attention problems can affect your short-term memory, and may make it more difficult to learn and store new information.

You may be more likely to have memory problems if you take high doses or more than one type of AED.

Memory problems rarely disappear completely following drug changes.

But taking AEDs may help to improve your memory by making seizures less frequent or by stopping them completely.

Mood and concentration can affect your memory.

Often the way you feel can affect how well you are able to remember information.

Feeling confident or happy can affect the way the brain works by increasing your ability to concentrate and take in information.

If you feel anxious or stressed, it’s more likely that your brain will have difficulties at the “learning” stage.

Also, when you have trouble recalling information, worrying might make it harder to find the correct information.

For some people, lack of sleep can make them more likely to have seizure.

For others, it may be that seizures during the night cause them to be tired.

Research suggests that getting good quality sleep can help make your memory more stable and preserve long-term memory.

In addition, age itself can affect storing and recalling information.

This might be because of the way the brain changes physically, and also because the demands on our memory can change.

Managing different areas of your life such as work, family, study and social life, can be complicated and may increase the chance of you forgetting things.

Then there’s surgery…

Memory problems are frequently reported following surgery for epilepsy.

This is most common with surgery to the temporal lobe.

Memory assessments are carried out before and after surgery.

But even if the surgery stops your seizures from happening, you may have memory problems afterwards.

Assessments are usually done by neuropsychologists who can advise on ways to manage memory difficulties.

Here’s the official lingo:

Long-term memory is information stored over a long time.

Semantic memory is knowledge and facts about people, places and things.

Episodic memory is memory about a specific events or episodes in our lives.

Prospective memory is memory for doing things in the future.

Procedural memory is memory for skills and how to do things.

Short-term memory, which is also called “working memory” or “attention span”, is information that is only kept for the length of time you need to use it.

Getting the information into our memory is called the encoding and then the consolidation process, and the separate process of getting it out again is called “retrieval”.

Some people have a problem getting information into their memory in the first place, while others find the retrieval challenging, and may just need a cue or prompt before they are able to retrieve a memory.

Interestingly, epilepsy-linked memory loss worries more patients than doctors! (Now how would they feel if they were on the other side of the table?)

Patients and doctors agreed overall on three of the top five concerns:

  1. Having a seizure unexpectedly…
  2. The legal right or ability to drive…
  3. Seizures not being controlled.

Doctors ranked problems with medication side-effects as their second-highest concern.

And both groups agreed that having a seizure unexpectedly was the number one concern.

“In a lot of cases, there was a fair amount of overlap, but the thing that the patients had on their radar screen that practitioners didn’t was the memory issue.

Memory was a concern for a larger percentage of the patients than we had anticipated,” said James McAuley, associate professor of pharmacy practice and neurology at Ohio State University and lead author of a study reported in the journal Epilepsy & Behavior.

“Indirectly, we address memory concerns in the clinic by addressing seizures. But we don’t typically sit down with a patient and say: Tell me about your memory.

This has heightened the awareness of our clinicians and should serve as a wake-up call to all practitioners treating people with epilepsy.

The mantra in our clinic is: No seizures, no side-effects, so uncontrolled seizures are seen as a medical concern by practitioners,” McAuley said.

“Patients tend to not want to have seizures because of the social stigma.

An interesting point in this context is that we believe in the clinic that if we can improve seizures, we will improve memory.”

Scientists plan to delve more deeply into this area of research by exploring what causes are behind memory problems that are reported.

“We’ll try to differentiate the cause of the memory problem and that will help guide us to either increase medication doses to get better control of seizures, decrease doses to eliminate side-effects, or use an antidepressant to address mood,” said McAuley.

“It’s quite a murky area and our goal is to learn more by dissecting the reasons for memory loss.”

I don’t think he’ll forget!

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Other articles of interest:

A neural device to restore memory


9 Ways To Get The Most Out Of Your Mind



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