Diagnosis Treatment of Memory Disorders in Epilepsy William

Diagnosis & Treatment of Memory Disorders in Epilepsy William B. Barr, Ph. D. , ABPP Chief of Neuropsychology NYU Comprehensive Epilepsy Center Associate Professor of Neurology and Psychiatry, NYU School of Medicine Annual FACES Epilepsy Conference April 27, 2014

Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

What is memory? Cognitive Disorders • • • Intellectual Functioning Attention and Vigilance Executive Functions Language Visuospatial Skills Memory**

Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

What is Memory? Types of memory Processing

What is Memory? Structure of Long-Term Memory (LTM)

What is Poor Memory? Brodaty et al. , 2002

What causes poor memory?

Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

BRAIN 101 Cerebral Cortex Limbic System

How is memory affected by epilepsy? Study of 55 patients with temporal lobe epilepsy: • Difficulties with memory reported in 77. 4%. • Reports of being “extremely bothered” by their memory disturbance in 13. 2%. • Over half (50. 9%) feel that “seizures interfere with my memory”. Data presented at the AES Meeting, 2003

How is memory affected by epilepsy? The most common memory complaints in patients with epilepsy Questionnaire completed by 55 subjects with focal epilepsy: • I forget a phone number if I don’t copy it down right away (47. 3%). • A word goes on the “tip of my tongue” but I can’t get it out (43. 7%) • I have trouble with remembering names of people I met last week (41. 8%). • I talk to someone on the phone and don’t remember minutes later (34. 5%) • I forget what someone said to me a half an hour ago (30. 9%). Data presented at the AES Meeting, 2003

Cognitive & Behavioral Impairment in Epilepsy

Antiepileptic Drugs (AEDs)

Treating memory impairment in patients with epilepsy Step Number One Optimize Medications: - Control seizures - Minimize number of AEDs - Use AEDs with least potential side effects Address Other Medical & Psychiatric Conditions: - Mood disorder, anxiety, or stress - Blood pressure, high cholesterol, etc.

Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

Neuropsychological Exam • • Interview Review of Medical Records Neuropsychological Testing Self-Report Inventories • Report • Feedback

The Normal Curve

Neuropsychological Test Battery • • Intellectual Functioning Attention and Vigilance Executive Functions Language Visuospatial Skills Memory** Self-Report Questionnaires

Memory Testing • Verbal Memory - • Word Lists Word Pairs Narrative Passages Visual Memory - • Designs & Figures Unfamiliar Faces Remote Memory - Public Episodic Knowledge Autobiographical Memory

Learn These Words Ballet Ice Cream Pie Penguin Zebra Play Goat Opera Cupcake

Remember These Figures

Free Recall 1. Tell me the words from the list. 2. Draw those figures for me.

Recognition Pie Cabinet Zebra Play Lake

Semantic Organization 1. Animals: Penguin, Zebra, Goat 2. Entertainment: Play, Opera, Ballet 3. Deserts: Pie, Cupcake, Ice Cream

Visual Memory Encoding

Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

Treating memory impairment in patients with epilepsy Step Number Two

Memory Treatment 1. Biological approaches 1. Psychological approaches 2. Lifestyle approaches

Memory Treatment Biological approaches § Psychopharmacology § Neurostimulation

Memory Treatment Pharmacological Approaches (Alzheimer’s disease)

Memory Treatment

Memory Treatment Neurostimulation a. Transcranial Magnetic Stimulation (TMS) b. Transcranial Direct Current Stimulation (t. DCS) Dayan, 2013, Nature Neuroscience

Memory Treatment Psychological approaches § Cognitive remediation § Personal mnemonics § Brain activation techniques

Cognitive Rehabilitation Major Strategies 1. External a) b) c) Environmental Manipulations Notebook, Calendar, and Checklist Systems Electronic Devices 2. Internal a) Mnemonics b) Bizarre imagery

Cognitive Rehabilitation Memory rehabilitation groups A. Education • Enhancing awareness of nature and severity of memory disturbance • Learning that others have the same types of problems • Teaching meta-memory skills B. Training in Use of Mnemonic Strategies • Visualization • Association

Improving Memory Cognitive Enhancement Techniques 1. Cognitive enhancement is the improvement or strengthening of mental skills including attention, memory, processing speed, and problem solving. 2. Cognitive enhancement programs or ‘brain-training’ interventions can target any of these core cognitive skills. 3. Usually, repetition of targeted activities is involved with the assumption that doing so will improve targeted cognitive domains and improve general mental faculties by enhancing neural connections and networks. From Jak, Seelye, & Jurik, 2013

Improving Memory Cognitive Enhancement Techniques

Improving Memory Cognitive Enhancement Techniques

Improving Memory Cognitive Enhancement Do these programs work? If so, which is better?

Memory Treatment Lifestyle approaches § Nutrition § Exercise § Relaxation strategies § Sleep

Memory Treatment Lifestyle Approaches

Memory Treatment Lifestyle Approaches

Memory Treatment Nutritional Supplements

Memory Treatment Lifestyle Approaches

Memory Treatment Lifestyle Approaches Sleep and Consolidation

Memory Improvement

Contact Info: William B. Barr, Ph. D. , ABPP NYU Comprehensive Epilepsy Center Departments of Neurology & Psychiatry NYU School of Medicine Phone: 646 -558 -0809 email: william. barr@nyumc. org Twitter: @WB_BARR