Introduction from Dr Markus Reuber, editor-in-chief of Seizure
Seizure 25 has published Memory in children with epilepsy: A systematic review
So many of the adult patients with epilepsy we see who are able to compare their life before the onset of epilepsy with their life after they have developed seizures are more concerned about their memory than their seizures. Even if patients’ understanding of what constitutes “memory problems” differs markedly from that of neuropsychologists (and even if the overlap of subjective memory concerns and “objective” memory test performance is only modest), this means that it is difficult for clinicians involved in the medical care of adults with epilepsy to ignore concerns about cognition.
In children the situation is more complex, especially when seizure have been present since early childhood. Patients and carers are much more likely to notice a rapid change of memory or cognitive performance than to be aware of static or gradually emerging deficits. What is more, children and their cognitive performance develop rapidly. Epilepsy, its underlying cause or treatment may not stop all development. It may simply cause cognitive development to occur more slowly or less fully than it would have done without the epilepsy – or without the underlying cause – or without the treatment. The fact that postoperative neuropsychological performance often improves in children who have undergone successful epilepsy surgery is an impressive reflection of how much better the brain can develop and function in the absence of epileptiform activity.
My editor’s choice from the present issue of Seizure is a review which focuses specifically on studies which have explored memory problems in children with epilepsy (1). This review was based on findings from 88 studies identified in a systematic search of the English language literature from 1993 onwards. The studies identified analysed memory performance in relation to different variables. Five possible predictors of memory performance were examined in more than five studies. The clearest predictors of memory impairment were a greater number of AEDs used, younger age at onset, higher seizure frequency and longer duration of epilepsy.
This review makes a very helpful contribution to the literature by bringing together the evidence from many studies and highlighting predictors of memory problems. However, what is just as important about this publication is that it demonstrates how many questions remain unanswered about memory problems associated with childhood epilepsy specifically and about wider cognitive problems more generally. How do these factors interact with each other? How do we differentiate between those patients whose cognitive problems can be improved with more medication from those who will bet better with less?
[1] Menlove L, Reilly C. Memory in children with epilepsy: A systematic review. Seizure 2015;25:126-35.