Epilepsy: there’s no need to keep forgetting anymore
What is epilepsy and do they get loss of memory?
Being an epileptic is not easy. Things are already tough with the impending fear that you might get a seizure at any time, plus the trouble with your friends. While seizures and shaking form the big picture of epilepsy, there are also other effects like memory loss. In epilepsy, patients usually forget the names of people they know, where they put their things and the purpose that they came into a room etc.
To understand why epileptics get memory problems, let’s delve into what exactly happens in epilepsy. Seizures in epilepsy occur when the brain shows abnormal electrical discharges. Our nervous system is built on electrical pathways, which is the reason why we shake in a seizure. The mechanism of memory is also complex, but scientists have a rough idea how it works. Certain areas of the brain are responsible for memory. Inside the temporal lobe of the brain, there are two structures called the hippocampus and the amygdala. The hippocampus is like the hard drive of a computer; it stores memories, and the amygdala is where your emotions come from.
How does our memory work?
The process of memory and recall has three stages. Compare your brain to a computer. To save a file such as an image or audio file, first you need to record it and encode it as a file. Your five senses pick up an event and send it to the brain to be converted to a recorded format. Next up, it needs to be stored for a period of time, which is where your hard drive called the hippocampus comes in. During a seizure, your brain is like the sky during a lightning storm. There are so many electric signals flying around. Your hippocampus may be hit by electricity, like a thunderbolt hits a tree, during a seizure and this damages your hippocampus and the memories that it has stored. Last but not least, we need to retrieve the information from storage and express it through an action or speech. The brain has two areas called Wernicke’s area in the temporal lobe and Broca’s area in the frontal lobe, which organizes your thoughts and words to result in proper speech. An attack to any of these places along the process of memory can occur during a seizure and result in memory impairment.
What are the different reasons for memory loss in epilepsy?
The longer that you have been having these seizures, as well as the age of your brain, matter a lot in memory loss. The more seizure events you have, the more damage you get. If your brain is already fragile as in old age, the damage may be more significant. Sometimes the brain might be affected due to a genetic cause as well. In addition, if you already have a psychiatric condition such as anxiety, depression or PTSD, your memory loss will be aggravated. The most likely cause for long-term epileptic patients would ironically be the medication given for seizures. The common culprits are clobazam, clonazepam, phenobarbital, zonisamide and topiramate. Topiramate in particular is notorious for causing difficulties in verbal memory and short-term memory.
What tests can be done?
A neurologist will do several tests for your memory loss. Because there can be multiple causes, they will first check thyroid functions, Vitamin B12, EEGs and sometimes even a brain MRI. It is very important to screen the patient for depression and anxiety as well. With regard to actual memory, they may do evaluations like the Montreal Cognitive Assessment (MoCA) and different other memory tests to measure different aspects like short-term and long-term memory. More sophisticated tests such as functional MRIs, Magnetoencephalogram (MEG) and Wada testing are usually reserved for advanced cases like pre-surgery.
How do we treat it?
The treatment depends on the underlying reason. The main focus would be to control the seizures as they cause the damage in the first place. Your doctor will review your current medication and make changes. If the medication itself is causing the memory loss, they will switch to a different drug like levetiracetam or lamotrigine, which does not majorly affect memory. If there is an underlying psychiatric disorder like depression, separate therapy will be given to overcome it. Meanwhile, it is always beneficial to have a healthy body, free from non-communicable diseases such as hypertension, diabetes, or high cholesterol, which provides a good background for proper memory function. Meanwhile, there are memory training programs called cognitive rehabilitation, which teach you exercises such as keeping a routine of the day, games or a calendar, a notebook to list your shopping list and daily tasks.
You don’t have to fret just because you keep forgetting stuff. But there is one important thing that you should not forget. It is to remember to consult your neurologist or epileptologist, because a lack of attention can make your memory problem get worse. Reach out, and they will help you remember once again.