Patty Shafer, RN, MN
Epilepsy.com Resource Specialist
This week Dr. Schoenberg and colleagues discussed one of the common problems that people with epilepsy report – changes in their thinking, memory, attention or other cognitive problems. Often seizure medicines are thought to be the cause of these problems, but just having epilepsy, and the impact of seizures on the brain or the underlying cause of the seizures is more often the major factor.
Am I at risk?
Most people with seizures will have general intelligence scores within a normal range. Yet specific types of cognitive problems may still be present that may be related to where the seizures come from or area of brain involved. Many people however may be at risk for changes, for example in different types of thinking or memory (for example, verbal or nonverbal material), slowed thinking, concentration or attention problems. It appears that people with uncontrolled seizures or a type of epilepsy associated with other neurological problems (for example, Lennox Gastaut Syndrome), are at greatest risk.
How can I tell if I have cognitive problems?
First of all, pay attention to yourself and what people close to you notice. Are you having more problems in school, work, or daily life? Is it taking you longer to do or remember things? Are those around you noticing changes that you aren’t aware of? If any of these questions sound familiar, start writing down the changes that you or others notice. Be as specific as possible and write down examples of what you have noticed and how often they occur. For example, do they occur only once in a while, before or after seizures, or constantly?
How are cognitive problems diagnosed?
A person’s report of problems is the first step in finding out what is going on. If you or your family notice problems, talk to the doctor who is treating the seizures.
Tell your health care provider about the cognitive problems- bring notes and examples. Ideally, write these notes on a seizure diary so the doctor or nurse can look at both seizures and cognitive problems!
The health care professional can do simple testing in the office – ask him or her what they notice after testing.
Ask for a referral for neuropsychology testing if it’s never been done before or if there is a change in thinking or memory problems. This testing is a critical part of a presurgical work-up and is very helpful for children who may be having learning problems and people who have problems at work or home.
Tell your health care professional about your seizures and medicines. Have they changed recently? Are seizures more frequent or doses of medicines higher than before? Since poor seizure control is a key cause of cognitive problems, treating the seizures will be very important!
If you are having more seizures, the doctor may want to bring you into the hospital for video EEG telemetry to find out the type and frequency of seizures. Having better information about the seizures will help him or her make changes in your treatment that could improve your thinking. Or, if medicines aren’t working, considering other treatment options may be considered.
Can medicines affect my thinking?
Some medicines do affect memory or attention. Many of the newer medicines don’t affecting thinking as much as the older epilepsy medicines. Talk to your doctor about possible changes in medicines. He or she may suggest changing your medicine to one that doesn’t affect thinking or memory. If a person is taking multiple medicines, maybe simplifying them will help – either seeing if seizures can be controlled with fewer medicines, lower doses, or a simpler way of taking them.
Where can I learn more?
Talk to your doctor and nurse, and make sure you meet with a psychologist to go over results of testing, what this means for you, and what you can do to help. Depending on the types of cognitive problems found, a psychologist can help you to learn ways to compensate for some of the problems.
Read more about learning, memory and cognition and the types of epilepsy on www.epilepsy.com. Understanding the type of epilepsy that you or your family member has will help you understand what to expect or what you may be noticing. Print out this information and take it to your doctor or nurse to find out how it relates to you.
These are only a few suggestions to get you started. Learning, memory, and cognition are big areas and our understanding of how this relates to seizures, medicines and other neurological problems is growing. The most important thing to remember is that living with epilepsy is more than just the seizures. Problems with cognition can affect people in many ways and it’s important to get a handle on this as soon as you can.
Hope you have a safe week! Best wishes to all.
by Patricia Osborne Shafer RN, MN
Resource Specialist, epilepsy.com
Last Reviewed: 12/12/2012
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