Learning to improve mental function

A complete treatment program for people with epilepsy should not only try to control seizures but also should try to reduce the distress caused by related impairments. One of the most common and troublesome impairments is difficulty with functions like attention and memory.

What kinds of rehabilitation programs have been studied?

Cognitive rehabilitation programs help the individual to be more aware of his or her own difficulties with various mental processes and then try to help the person improve through one or both of two approaches. A study reported in the journal Epilepsia found that patients with partial epilepsy and poor performance on tests of attention improved their abilities and quality of life as a result of two types of cognitive rehabilitation programs:

• Retraining involves practicing tasks repeatedly on a computer to try to restore the automatic behaviors that have been lost from damage to brain cells.
• Compensation involves teaching patients strategies to get around their impairments in daily life.

All 50 patients in this Dutch study were also being treated with the seizure medicine carbamazepine (Tegretol or Carbatrol) at the time of the study. More than one-third had been seizure-free for at least 2 years. They were divided into three groups:

• a group that received retraining
• a group that was trained in compensation
• a group that did not undergo rehabilitation.

The first two groups attended six weekly 1-hour cognitive rehabilitation sessions. The people in both of these groups had improved scores in tests of attention and memory that were related to their training. Those in the group that did not attend the sessions also showed some improvement, but it was significantly less for most of the tests. Improvement was still found when the groups were retested 6 months later.

Both of the rehabilitation groups also reported fewer problems in their daily lives with things like absent-mindedness, and they reported a better quality of life related to mental health than the group that did not go through rehabilitation.

Who benefits most?

An interesting finding was that people who had only a high-school education benefited more from compensation training than those who had more education. The authors speculated that the more highly educated people may already have developed their own compensation techniques. They suggested screening these people for awareness of such strategies before enrolling them in a lengthy program.

Another important point is that people who were not seizure-free showed more improvement from the cognitive rehabilitation than the others at the 6-month follow-up. Although a firm recommendation cannot be based on just one study, the findings suggest that people with epilepsy ought to discuss with their doctor or neuropsychologist whether cognitive rehabilitation might benefit them and help them to improve the quality of their lives.

Want to know more?

Here's where to find a more detailed report of this study:

Engelberts NH, Klein M, Ader HJ, Heimans JJ, Trenite DG, van der Ploeg HM. The effectiveness of cognitive rehabilitation for attention deficits in focal seizures: a randomized controlled study. Epilepsia 2002 43:587-595. PMID: 12060017