Seizures and Memory Loss: Epilepsy’s Toll on Cognition

Understanding the connection between epilepsy and memory

Experiencing memory loss even long after a seizure is over can feel confusing and frustrating. Finding it harder and harder to recall memories, Chris had to give up a job with an inventory company.

Nancy’s memory loss and impacts on her cognitive function forced her to quit her job as an ultrasound technician. She eventually had to leave her position as the stage manager for her local community theater group, too.

“I couldn’t wrap my brain around the complexities of the shows anymore,” she says.

Epileptic seizures were to blame in both cases — a condition that started at age 8 for Chris and age 48 for Nancy. Up to 40% of people with epilepsy experience challenges in their cognitive function.¹ Cognition includes memory, language, and executive function (attention, concentration, problem-solving and other skills needed to make and meet goals).

With epilepsy, impaired cognitive function can interfere with daily life, and not just on days with seizures. The effects of seizures on memory or other thought processes can linger after the seizures. In some people, these functions can worsen over time. Anti-seizure medications can also affect cognition, as can overlapping health conditions, lifestyle factors and aging.^2,3

To complicate matters, some anti-seizure medications can also interfere with cognition, mood and memory, including:^2,4

• Phenobarbital
• Carbamazepine
• Phenytoin
• Valproate
• Topiramate
• Clobazam

Some people treated with deep brain stimulation (DBS), a potential option for harder-to-treat seizures, also report memory, concentration and mood problems.⁵

Other factors — various health issues and aging, among them — come into play as well. Lifestyle influences such as stress, lack of physical activity and poor sleep, as well as the use of alcohol, can all lead to cognitive decline. Anxiety and depression, which can occur more frequently with epilepsy, can play a role, too. (Learn more about mental health challenges with epilepsy.)

Fortunately, researchers have worked to untangle why seizures can harm cognition, which can include memory loss, and what can be done about it.

How can epilepsy impact the brain?

People with epilepsy may experience changes to brain tissue called gray matter, which consists of neurons (brain cells). Another type of brain tissue called white matter, which contains fibers (axons) that transmit nerve signals, may also be impacted. It’s unclear what causes this — the seizures themselves or the brain changes that trigger them.

Regardless, the actual impact on function, and the brain’s ability to overcome this impact, varies from person to person. Developing epilepsy at a young age seems to raise the risk, as does the number of years a person has lived with the condition. The type of epileptic seizures and their frequency seem to matter, too.²

Tonic-clonic (grand mal) and focal impaired awareness seizures can cause the greatest impact.⁶ A status epilepticus emergency — a seizure or series of seizures lasting more than 30 minutes without relief — can also cause serious harm, possibly even death.⁷

Other types of epilepsy can affect certain locations in the brain and particular aspects of cognition:

• Absence epilepsy: Attention⁸
• Benign epilepsy with centrotemporal spikes (BECTS): Language abilities^9,10
• Frontal lobe epilepsy (FLE): Executive function¹¹
• Juvenile myoclonic epilepsy (JME): Executive function^12,18
• Temporal lobe epilepsy (TLE): Memory^3,11

Understanding the possible influences of seizures and of antiseizure medications on cognition, memory and mood may require specialized testing — testing that can help identify potential solutions.

A conversation with your neurologist about your cognitive concerns could lead to discussion and recommendations for:

• Additional testing and assessment
• Better seizure control
• Care for additional medical conditions
• Changes in medications or doses, if possible
• Greater mental health support
• Improved sleep
• Lifestyle changes — eating healthy, engaging your mind, staying active, avoiding isolation
• Specialized neuropsychological testing

If your seizures are not controlled by medications, or if you are having side effects on your medication, consider working with an epileptologist, a neurologist with extra training in the diagnosis and treatment of epilepsy.

Doctors may recommend pursuing surgery to remove or destroy brain tissue at the source of the seizures. But when such surgery isn’t possible, safe, or desired, then neurostimulation, such as with the RNS System, may help reduce the frequency and intensity of seizures. As compared to other approved neurostimulators, (learn more about RNS, VNS, and DBS) in clinical studies, the RNS System did not negatively affect memory or cognition.^14,15 In fact, some participants reported improved memory and cognition after just one year.*

Additionally, the RNS System generates data that can help doctors make decisions about existing medications, such as changing doses or switching drugs.

In Massachusetts, Christine was able to stop taking two medications and lower the doses on the remaining two* after receiving the RNS System.

“Once I stopped taking as many drugs, it felt like someone pulled open the curtains and let in more light,” she says. “Suddenly I could think more clearly and remember things in sharper detail.”

Individual experiences with epilepsy and responses to treatment always vary, but Nancy and Chris both found that the RNS System provided seizure control and cognitive benefits. Friends and family started telling Nancy she seemed more focused and engaged in conversations. Chris went from being “pretty forgetful” to easily remembering what other people had said or done.

“My family was amazed that I could rattle off my plans and schedule for the next two weeks,” Chris says.

Other Resources for Epilepsy and Memory

• Watch the Epilepsy Foundation’s webinar Epilepsy and Cognition, sponsored by NeuroPace
• Find help through the Managing Epilepsy Well (MEW) Network, a program of the Centers for Disease Control and Prevention (CDC)
• Join the HOBSCOTCH Memory Program from the Epilepsy Foundation

References

1. Wang et. al., 2020. Brain and Behavior.
2. Novak, Vizjak and Rakusa, 2022. Journal of Clinical Medicine.
3. Bruce Hermann, 2020. Epilepsy Foundation. [Video; 47:15]
4. Bruce Hermann, 2020. Epilepsy Foundation. [Video; 13:42]
5. Indications, safety, and warnings deep brain stimulation therapy. Medtronic.
6. Aldenkamp, 1997. Epilepsia.
7. Power, 2018. Epilepsy Research.
8. Cerminara et. al., 2013. Epilepsy & Behavior.
9. Teixeira and Santos, 2018. Epilepsy & Behavior.
10. Jurkevičienė et al., 2012. European Journal of Paediatric Neurology.
11. Thinking and Memory, updated February 4, 2022. Epilepsy Foundation.
12. Kim et. al., 2007. Journal of Clinical Neurology.
13. Sonmez et. al., 2004. Epilepsy & Behavior.
14. Loring et. al., 2015. Epilepsia.
15. Meador et. al., 2015. Epilepsy & Behavior. NeuroPace Summary of Findings. [PDF]