Medicines and Memory

As a writer for this website, I was asked to interview Dr. Daniel Drane, a neuropsychologist who deals with memory issues in epilepsy patients. Dr. Drane received a Ph.D. from the Fuller Graduate School of Psychology. He is currently practicing at the University of Washington's Epilepsy Program.

Dr. Drane had a few remarks about his experiences with patients who were taking various kinds of seizure medicines.

What effects on thinking might be due to seizure medicines as opposed to something else?
With the antiepileptic drugs, their whole purpose is to decrease neuronal irritability. The cells in the brain, the neurons, are causing electrical discharges that are unwanted, disruptive. You're giving drugs to stop these abnormal cells. These drugs can also have some sort of neuronal dampening effect on the whole brain. So they can affect things such as attention, processing speed, things that depend on your being alert. So if you start having problems with attention and so on, that can impact your memory—not so much that you really have a memory problem, but that the structures in the temporal lobes that are important to memory aren't working. The drugs may be keeping you from focusing on what's going on around you and being able to be alert and sharp.

I think that drugs have a greater impact upon children who are developing and going to school and upon people who have some type of really focused job where they have to pay constant attention. They need to be attentive and alert, and so it becomes a major issue there. If you are an air traffic controller and have to monitor a little screen and be sharp, then medications can impact this (although they may not in every case).

I'm certainly not knocking antiepileptic drugs. For people who aren't in school or doing something really demanding, I think the tradeoff of not having seizures is worthwhile. If you maintain the standard therapeutic range on the drug and if you avoid taking too many medications, then those effects tend to be pretty minimal, except for some individuals and some particular drugs.

Is there any difference between the newer seizure medicines and the older ones?
Some of the older, more established antiepileptic drugs (such as Dilantin, Tegretol, and others of that sort) have certain problems. So do some types, such as barbiturates, that typically aren't used any more.

For the newer drugs, the early studies on cognitive effects haven't been all that different. They seem to cause mild problems in the same sorts of areas—attention and motor speed—and they don't look that much different from the older drugs. They may be better in some ways, such as improving seizure control and management. Some of the older drugs have been shown to impact mood, and some newer ones appear to have some beneficial role there as well. Overall, both of these things still need to be researched much more. There aren't enough studies to really know exactly how the newer drugs stack up to the older ones.

This surprises me. Some of the newer medications have been around for a decade. I wonder why more (or better) studies haven't been done?
Some things have occurred with newer seizure medicines. Topiramate [Topamax], for example, gets a bad reputation because some studies suggest that since it is a very powerful drug, the effects seem to be greater in some people, particularly if it's not titrated properly. If the dose is increased too quickly, some people seem to have deficits on some cognitive tasks. But again, it does control seizures well; it does have some advantages. So for a particular person, if you can optimally manage their seizures with it, it still may be a good choice.

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