Since epilepsy is the thing that I have been writing about this semester, I figure I will stick with it. I know I have already addressed some of the adverse effects of the medications used to treat the disorder, but now I am going to delve deeper into the side effects poly (multiple) therapy versus momo (single) therapy. Specifically, how they differ in the side effects. For example, often times the more medications a person takes the greater number or more severe side effects.
Witt, Elger, and Helmstaedter (2015) conducted a retrospective study on the effects of the number of medications patients take as treatment. The cognitive assessment used by all of the studies that they looked at used EpiTrack, which “assesses response inhibition, visuo-motor speed, mental flexibility, visual motor planning, verbal fluency and working memory” (p. 1955). Through the assessment of the data collected from the other studies, it was determined that the number of medication a person takes does tend to increase side effects. The dosage of the medications also have an impact.
My experience with this just happens to be with verbal fluency. As I may have mentioned earlier, I have issues with keeping what I want to type in my mind long enough for me to type it. I also have a great amount of difficulty conversing with people. In my opinion, it is the most frustrating side effect that I have experienced thus far. Actually, just today I told my husband something that he told me that I had already told him yesterday! As Witt, Elger, and Helmstaedter (2015) state, “With regard to the cognitive side effects of antiepileptic pharmacotherapy, the presented data indicate that each additional drug matters” (p. 1959). If I failed to mention this earlier this semester, I am currently on four antiepileptic medications. On a final note, one of the medications was just recently increased, so I am still adjusting to it. I am just hoping I can tolerate it.

References:
Witt, J., Elger, C. E., & Helmstaedter, C. (2015). Adverse effects of antiepileptic pharmacotherapy: Each additional drug matters. European Neuropsychopharmacology, 25, 1954-1959.

For now, I am going to continue talking about epilepsy. However, this time you all get to hear about one of the lovely side effects that comes with having seizures, as well as the current treatments for them, specifically medications. I will be focusing on memory because it is the one of the most difficult cognitive issue that I deal with on a daily basis. As I was doing my research, I noticed that no one seemed to be concerned with which process of long-term memory was being effected. However, at least there are finally therapies for the cognitive issues related to epilepsy.
A study conducted by Witt and Heimstaedter in 2012, found that 47.8% of their subjects experienced memory deficits. Other studies have shown that “greater impairments on testing correlate with… longer duration of the seizure disorder, earlier age of onset, greater seizure frequency…” ( Leeman-Markowski & Schachter, 2016, p.184). Leeman-Markowski and Schachter also mention that patients who have TLE (Temporal Lobe Epilepsy) are prone to having memory loss, sometimes verbal and sometimes general memory issues. The medications used to attempt to control seizures also can cause cognitive side effects.
The older antiepileptic drugs (AEDs) are said to have a higher risk of causing problems with “response inhibition, verbal fluency, attention and vigilance, psychomotor speed,… and memory, as well as subjective confusion and memory loss” (Leeman-Markowski & Schachter, 2016, p.186). One of the newer AEDs that I am on and am experiencing the side effects from is zonisamide. According to the article written by Leeman-Markowski and Schachter (2016), it has been found that the most common possible side effects cause “deficits in verbal intelligence, verbal learning, delayed verbal and nonverbal memory, and verbal fluency”. In other words, I am often making long pauses, or say things like “umm…”, in the middle of speaking because I lost my train of thought. Even composing this entire post has been a challenge because my ability to recall what I want to say is a challenge. There have also been many times that I have had to look up the definition of words, even ones that I have “learned” in the past, because I have no idea what they mean. Needless to say, it is extremely frustrating, not only for myself but for the people around me as well.
As far as treatments go, the first listed is to keep the pharmacological use to a minimum. In other words, try to avoid using more than one AED at a time, when possible, and keep the patient at the minimum dose of the AED(s) possible. Besides that, the most common treatment for the issues listed above is cognitive rehabilitation, which usually incorporates things like direct retaining, external compensatory strategies, and internal compensatory strategies. The issue with these types of treatment is that they may work for one deficit, but not work for others. For example, a study conducted by Engelberts, Kein, Ade et al. (2002), found that even though there was improvement in patients’ attention with the use of both direct retraining and compensatory strategies, the improvements did not apply to things that were not directly related to the training program. Treatments that are under investigation are mostly comprised of Alzheimer’s treatments, which there is not much information about right now.
While I have no idea whether the memory issues associated with epilepsy are caused by encoding or recall problems, they are none-the-less annoying. Hopefully one of these days, the cognitive issues associated with epilepsy will be a thing of the past. I am just hoping that it happens in my lifetime.

References:
Leeman-Markowski, B.A. & Schachter, S.C. (2016). Treatment of cognitive deficits in epilepsy. Neurological Clinics, 34, 183-204.

Brain imaging is always used in planned brain surgeries. For example, before neurosurgeons will consider operating on a patient with uncontrolled focal epilepsy they require a multitude of tests; a fMRI is one of the most important. I am going to through it so that every function is location can be identified, as well as determining whether or not the risks of damage being caused by surgery are too great. The fMRI is even able to pinpoint functions, including memory and language, to the hemisphere that they are most prominently used in.

In the context of the cerebral cortex, hemispheres can be defined as the identical twins of one another. They both have the same lobes, which in an average brain usually serve the same functions as its “twin”. However, the two hemispheres are a bit interesting because they control the opposite side of a person’s body than the side that they are located. In other words, the right hemisphere of a person’s brain controls the functions of the left side of the body, while the left one controls the right side of a person’s body.

The fMRI evaluations provide information about both hemispheres, as well as the lobes. During the evaluation that is used for surgery, the patient is asked to do a multitude of tasks that are recorded using the FMRI. The technician may ask the person to do something related to voluntary motor function, using one side of the person’s body at a time, in order to pinpoint the exact location within the lobe(s) of voluntary motor function control, not just its general location. As for functions like memory, the doctors are more interested in where memories are mainly stored and processed. Those functions are usually mostly stored on one of the hemispheres.

If performing surgery on the focal point, also known as the origin of the person’s seizures, will cause major damage to these areas then the person is told that they are not a candidate for surgery. However, if it seems that surgery will cause no major damage to these areas then the person is told that they may be a candidate for surgery. I say may be because some patients require further testing.