Memory Rehabilitation in Patients with Epilepsy: a Systematic Review

Abstract

Memory failure is a common clinical concern of patients with epilepsy and is associated with significant functional impairments. Thus, memory rehabilitation is of critical clinical importance. In this article, we aimed to systematically evaluate the efficacy of memory rehabilitation in patients with epilepsy. The Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to guide searches, extraction and reporting of data in this review. PsycINFO, Medline and PsychBITE searches yielded 95 studies. Twelve papers met inclusion criteria, reporting outcomes of cognitive or behavioural interventions that specifically targeted the rehabilitation of memory in patients with epilepsy. Methodological rigour was rated using the Single-Case Experimental Design (SCED) scale for single-case studies and a modified version of the Downs and Black checklist for group studies. Twelve prospective studies, nine group (six pre-post design, one waitlist crossover, two randomised controlled trials) and three single-case studies were identified. Eleven of the studies included adults, eight of which involved adults with temporal lobe epilepsy (TLE). One paediatric study was identified. The quality of group studies ranged from 36% (poor) to 72% (good), using the modified Downs and Black checklist. Single-case studies were assessed using the SCED scale and assessed to range in quality from four to seven out to 11. Overall, memory rehabilitation was associated with improved memory function in all studies. Verbal memory outcomes were most commonly examined and associated with improvements. This review found that the level of evidence available to support rehabilitation of memory in patients with epilepsy was generally weak and inconsistent. Nevertheless, studies conducted to date, albeit of limited methodological quality, offer preliminary evidence that memory rehabilitation is associated with improvements in verbal memory in patients with temporal lobe epilepsy. Little is known about the efficacy of memory rehabilitation in patients with non-TLE, children, and other aspects of memory difficulties. Guidelines for future research are proposed.

Systematic Review of Accelerated Long-term Forgetting in Children and Adolescents With Neuropediatric Diseases

“…8,14,[25][26][27][28][29][30]34 Figural memory recall was tested in 5 studies, all of which investigated children with epilepsy. 25,[28][29][30][31] Four different assessments were used (scene memory, 40 spatial memory, 41 dot locations, 37 and the spatial object location task 29 ). Figural recognition performance was not assessed.…”

Rehabilitación neuropsicológica en memoria declarativa y la funcionalidad en un adulto con epilepsia y lobectomía temporal izquierda.

“…Otro estudio exploró por medio de una revisión sistemática, la eficacia de la rehabilitación de la memoria en pacientes con epilepsia; para esto, se eligieron 12 artículos y 8 de ellos eran pacientes adultos con ELT, los investigadores concluyeron que la RN de la memoria estaba asociada con mejoras en la memoria verbal, aunque expresaron que había poca evidencia sobre rehabilitación de la memoria en pacientes con epilepsia. 45 Los resultados del presente estudio se contradicen con los informados por Thompson y otros 46 quienes indican que el uso de ejercicios de entrenamiento cerebral en internet no se asoció con cambios en las puntuaciones de las pruebas que evalúan memoria como son el recuerdo de una lista de palabra y de una historia, pero hubo una relación con las calificaciones subjetivas de memoria, de depresión y el número de juegos de memoria jugados. Por otro lado, no se encontraron estudios de caso único en donde se haya realizado RN en adultos con LTA por medio de las TICs, como es el estudio de Mosca y otros 47 estos implementaron estrategias de imaginería visual y su impacto en la memoria verbal, pero no se incluyeron intervención por medio de la tecnología ni instrumentos que evalúen funcionalidad.…”

“…Además, las investigaciones mencionadas se encargan de medir los desenlaces con pruebas cognitivas en vez de utilizar medidas funcionales, las cuales permiten evidenciar desde un aspecto más ecológico, el impacto de la intervención en la vida cotidiana de los pacientes. [44][45][46][47]…”

Life following epilepsy surgery: Building a holistic framework for enhancing postsurgical recovery and rehabilitation

“…Preparing patients for surgery and supporting them through the process of adjustment that follows requires a patient-centered approach. [13][14][15] We advocate a holistic yet flexible approach where advice is tailored to each patient's needs. 16-18…”

“…Patients can often have medical, cognitive, and psychosocial challenges that are unique to their circumstances, and these vary widely across the population. Preparing patients for surgery and supporting them through the process of adjustment that follows requires a patient‐centered approach 13–15 . We advocate a holistic yet flexible approach where advice is tailored to each patient's needs 16–18 …”