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After most complex partial and all tonic-clonic seizures, memory is impaired for a period of time. Is it coincidence that impaired anterograde memory is a common interictal cognitive disorder? Do postictal symptoms predict future interictal symptoms? Postictal psychosis may evolve into interictal psychosis (1). Personal observation also suggests that in some patients without prior psychiatric history, periods of postictal depression develop and are followed years later by severe interictal depression. Can treatment of seizures and postictal symptoms provide an opportunity for prevention?
Romberg (2) (1853) recognized that memory impairment was the most common interictal disorder. Patients complain of impaired recall for recently learned information, especially details and names. Left temporal seizure foci (partial seizure disorder arising from left temporal lobe) impair mainly verbal memory, and right temporal foci impair recently acquired visual, spatial, and geographic memory. Although patients with TLE show memory impairments on 30-minute delayed-recall tests, longer delays demonstrate even greater impairment (3). As in other cognitive disorders, several factors contribute to interictal amnesia, including structural lesions (physical abnormalities in the brain, such as a stroke, scar, tumor, etc)(4), neuronal dysfunction or loss, interictal epileptiform discharges (5), recurrent seizures, and antiepileptic drugs (6–8). Interictal hypometabolism marks hypofunction, correlating with impaired memory when it involves the medial temporal memory structures (9).
Treatment of interictal memory disorders
How do we treat interictal memory disorders? Improved seizure control, reduction or elimination of AEDs that adversely affect cognition (e.g., phenobarbital, topiramate) (10,11), and better sleep habits improve memory in some patients. Pragmatic approaches include use of visual imagery, lists and schedules (displayed prominently), learning to take simple and clear notes, small portable notepads organized by topic, carrying important telephone numbers and addresses, and use of alarms as reminders. These strategies often fail to fulfill the needs of higher-functioning patients with demanding jobs. No medications are proven to enhance memory in patients with epilepsy (12).
Phytomedicinal extracts from Ginkgo biloba leaves are used as dietary supplements. The main active compounds in the leaves are flavonoid glycosides and ginkgolides. Although uncontrolled studies show improved memory function in demented and elderly subjects, controlled studies do not demonstrate efficacy (13,14). The only safety concern with ginkgo is a possible increase in the risk of bleeding, especially in patients taking warfarin (15).
Reproduced and adapted with permission from Orrin Devinsky, M.D. and Epilepsia.
Topic Editor: Steven C. Schachter, M.D.
Last Reviewed:7/26/04
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