Notes from a lecture by Clare Brandys, Ph.D., C.Psych., Psychologist, Clinical Neuropsychology.

Note: This information provides general principles only. For more elaborate and individualized information it is recommended that interested people contact their own health care providers.

Why do people with epilepsy often have memory problems?

Your memory process can be interfered with by epileptic seizures. Or an underlying disorder in the brain, which causes the seizures, may be what is disrupting the memory process. It may be the effects of your anti-epileptic medication. Or it may not actually be a memory problem at all.

How can seizures cause memory problems?

Memory is a natural brain process that requires continuing attention and recording by parts of the brain. Seizures interfere with memory by interfering with attention or input of information. Confusion often follows a seizure, and during this foggy time new memory traces are not being laid down in the brain. Tonic-clonic (grand mal) seizures in which you lose consciousness can interfere with normal brain processes and disrupt the registration phase of short-term memory. Sometimes longer term memories from the period prior to the seizure are lost as well, as these memories may have not yet being fully integrated into the brain’s memory system. If a seizure is very severe and prolonged (status epilepticus) and you experience hypoxia (insufficient oxygen to the brain), this can cause secondary damage to your memory system.

What else can cause memory problems?

An underlying brain tumour or lesion can disrupt the memory process. Or if the focus of your seizures is located deep in the temporal lobe of your brain near some of the parts that are important for memory (e.g. the hippocampus), this may be causing your problem. Some people with epilepsy have unusual electrical activity in their brains between seizures – what is known as “inter-ictal” or “sub-clinical” activity. This can interfere with attention and also, probably, with memory.

Or perhaps you are experiencing a cognitive problem (e.g. an attention problem, language problem, or a visual/spatial problem) and not a true memory problem. Perhaps the problem is emotional and not memory-based, brought on by anxiety in certain situations or by depression. Your ability to recall may be interrupted by your mood or by sleep disturbances.

Can anti-seizure medications cause memory problems?

Anti-seizure medications may affect your thinking and memory, but on the other hand, they may control your seizures, and having lots of seizures can lead to more memory loss. Discuss the side-effects of your medication with your neurologist. Do not stop taking your medication on your own.

Are all memory problems the same?

No. Learn more about your specific memory problem. Do you have memory lapses following a seizure? Do you have fluctuations in your memory, where it is better some times more than others? Are the fluctuations related to stress, or to certain kinds of tasks or situations? For example, is your memory worse when you are in a particular place or with a particular person? Many kinds of memory problems are stress-related. Can you remember things if you are given a prompt or cue? Do you have a better memory for pictures (visual type memory) than words (verbal type). Memory is lots of different processes. Learn which ones you rely on in order to maximize your strengths and accept your limitations.

What are the processes of memory?

There are many different ways to classify how memory works. Some people rely more on their verbal memory, remembering in terms of words or sounds, whereas others use their visual memory, relying on pictures or spatial relationships. Which process works best for you? There is semantic memory, referring to knowledge-based memory of a particular topic, like the history of World War I, for example. This differs from episodic memory, or memory of a particular event, such as an outing you were on last week. Most of us have heard of short-term (or working) memory vs. long-term memory, which really refers to the memory of things in the recent past.

Getting the information into our memory is called the encoding and then the consolidation process, and the separate process of getting it out again is called retrieval. Some people have a problem getting information into their memory in the first place, whereas others find the retrieval challenging, and may just need a cue or prompt before they are able to retrieve a memory. Start to notice which memory processes are working well for you so you can play to your strengths and minimize your weakness.

Do my emotions play a role in my memory problems?

Try to learn more about how you operate. There may be situations that are important to you where your memory problems keep interfering, but there are other situations of less value to you when it should be less of an issue. What are the demands on you and what do you do? You may be making your problem worse by being mad at yourself when you can’t remember something. If you make a memory mistake, don’t fight it and impair your cognitive skills further, just move on. Trying harder usually won’t help you remember. An emotional attitude of acceptance and accommodation is more beneficial to memory than self-defeating behaviours or thoughts. Chances are your memory problem is not going to go away, so keep your expectations reasonable and look at ways to work around the problem.

What are the most common everyday memory problems?

According to one survey of the five most common memory problems, first is being unable to come up with a word that we feel is “on the tip of our tongue”, apparently because of a verbal memory processing problem. Second is having to go back to check to see if something was done, such as turning off the stove, probably reflecting a failure to pay adequate attention at the time. Third is forgetting where we put something, probably a visual-spatial memory process problem. Forgetting the name of someone or thing is fourth, apparently a verbal memory malfunction. Not remembering what has been said or been told is another. The types of problems people have vary, and how serious a nuisance the problems are varies from person to person as well.

Do memory problems ever improve over time?

If your memory problem is the product of a newly acquired brain injury, you may have a period of spontaneous recovery as the brain cells reorganize during the period right after your injury. However, if more than a couple of years have elapsed since a brain injury, significant change is not expected, and after two or three years all the recovery will likely be completed. If your memory problem is rooted in something that happened 20 years ago, a natural recovery is unlikely at this point. Accepting that there is no “cure” for such memory problems is important. But strategies can still help you work around the problem.

Can memory be improved through mental exercises?

Staying mentally active is a good thing, but it won’t really help your memory problem. Research has shown that playing memory games or doing exercises to sharpen your memory doesn’t help your memory in general. Memory is not a muscle: exercising it doesn’t work. What is more useful is developing techniques and strategies to help you cope with your memory problem.

What can I do to live better with a memory problem?

Memory coping is about good memory habits, developing a healthy “memory diet” (like the four food groups). Improved results can occur if you allow the type of memory that works best for you to compensate for another type; for example, using pictures to help you remember if your visual memory is stronger. Use consistency, and control what you can to make remembering easier. Telling other trusted people that you have a memory problem is an excellent technique-they can help by cueing you. Just saying, “I tend to forget that, I would appreciate it if you would give me a reminder” can make all the difference in the world. Don’t be afraid to rely on others. Recognize that your mood and stress can contribute to memory problems. Keep your expectations for yourself reasonable. And be flexible in your approach to fit the memory demands on your memory.

What are some good memory habits?

• Accept (that one) cannot cure
• Use remaining capacities
• Pay more attention
• Spend more time
• Repeat
• Make associations
• Organize
• Link input and retrieval
• Take notes

What are some formal strategies for helping the memory process itself?

The memory process consists of getting the information in, keeping it in, and then getting it out again. You can actively work on getting the information in-encoding it-by simply paying close attention to the specific things you want or need to remember. Many people have problems remembering the name of someone new because at the time, they aren’t really paying attention to the name itself. Distractions get in the way of really attending to new information, so cut out distractions wherever possible. Repeating or rehearsing the information-saying it more than once– will help encode it. Elaborating on it, exaggerating it, organizing it, or associating it with something else meaningful to you are other ways we increase its impact on our memory processes. For instance, you may take someone’s name and make up a whole outrageous picture or elaborate association with something else it reminds you of. These techniques help our brain to process the information on more than one level and to make more connections. Research shows that the memory trace is stronger if it has more connections in the brain– the information will simply stick better. Chunking or breaking down information– a telephone number, for example– into smaller, easier to remember “chunks” is another strategy for more effectively encoding material.

I recommend The Page a Minute Memory Book by Harry Lorayne for lots of simple and practical day-to-day memory strategies.

What are some other formal memory strategies?

Lots of material lends itself to using mental pictures or imagery to help us memorize it, especially if your visual memory is what works best for you. You can use “pegs” to help you memorize a sequential list. With the peg method, each number has a rhyming visual cue, for example “One, bun, Two, shoe, Three, tree, Four door,” and you visualize the first thing you want to remember on a bun, etc. The more of your senses or modalities you use, the more likely you are to remember it. For instance, writing out someone’s name will help you remember it, but writing it in sand (touching it) as well as hearing it would “cross code” it and make it more likely to “stick”. Some people find first letter clues help them memorize lists, like “Every Good Boy Deserves Fudge” for the musical scale EGBDF. Other people weave information into a “story” that uses elaboration, exaggeration and visualization– cross coding it to help them remember.

What are Memory Groups?

Groups of people who get together and support each other’s use of memory strategies are called “Memory Groups”. These can be very helpful to people who find they are not coping well with their memory issues or who want to share experiences with others.

Will using natural remedies help my memory?

Natural herbal remedies for memory are unproven. Some people take a substance called Gingko Biloba for their memory. My position is that I can’t specifically recommend Gingko Biloba, although as far as I know it is not harmful. Another natural remedy is Ginseng, which, as a stimulant, may help alertness, which is a part of the memory process. Certainly, we learn better when attentive. Make sure your epilepsy doctor knows what substances you are taking, if any.

How can I take control of my memory problems?

Acknowledge that you have a memory problem. Presume that you will have a memory problem tomorrow. You have got this, so live with it as best you can. Don’t set yourself up for defeat. If you think that you are likely to forget something, don’t test yourself to see if you do. Instead, do what you can to reduce the number of things you have to remember. You can restructure your environment so you don’t have to use your memory as often. Use external aids to help you. For instance, if you want to remember to take something with you when you go out, put it by the door when you think of it so you don’t have to remember it later. Put signs and labels on things so you don’t have to remember them. Take control of your world. Who cares if you don’t get everybody’s name right?

What other external aids can I use?

Write things down in a diary, notebook, calendar or list so you don’t have to remember it again. Or record them on a portable tape recorder or dictaphone while you are thinking of them. Employ sensory cues to remind yourself to do something: a beeper, alarm watch, or simply tie a string around your finger (as long as that cue is specific enough for what you have to remember!). Technology can be a great help with new devices like electronic organizers, watches that record phone numbers and the new Neuropage system that tells you when to take your medications, etc.
How can I enjoy reading books when I forget what I have just read?

This can be a challenge. Try reading out loud to help you pay closer attention to what you are reading. Or use a highlighter to visually exaggerate certain key phrases as you read. Or try taking notes as you go along. Translating what you have just read into your own words can help commit it to memory. Make a special point of including it in a conversation soon after you’ve read it. Exaggerate it to strengthen the memory trace.

What hints can you give someone with memory problems?

Memory coping is about good habits and working around the problem. Try to relax: stress may make your memory worse. Be flexible: different types of information may require different memory methods. Be committed, motivated: paying more attention takes effort. Try again if one method fails: things may not turn out as you planned. Try not to dwell on all the things from the past that you wish you could remember. Pay attention to what is going on now so you can make some new memories. Look ahead, not behind. Also, don’t forget to celebrate your memory successes!