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Does Epilepsy Affect Intelligence?

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Much better! (Photo credit: Jacob Johan)
Deutsch: Gehirn lateral, Lobi

Among neurological disorders, epilepsy is the third most common, affecting 1-2% of the population. Intellectual, psychiatric, and social-adaptive functioning can be affected in people with epilepsy. Research has been accumulating over decades, and the complex interaction between seizures and intelligence are becoming better understood. 

For any disease involving the brain there is the potential for impairment in intelligence and behavior. Most patients with epilepsy have normal intelligence, but some can have deficits in intelligence, memory, or other cognitive functions. This depends on multiple factors, including the epilepsy type, the cause of the seizures, the extent of brain damage if any, the seizure type(s), seizure control, medications, etc. On tests of general cognitive ability (so-called IQ tests), most individuals with epilepsy score normally. For example, individuals with “idiopathic” (genetic) have normal IQs. Individuals with focal (localized) epilepsy also usually have normal intellectual functioning. However, individuals with epilepsies caused by diffuse brain damage, such as Lennox-Gastaut syndrome, usually have cognitive deficits, including intellectual disabilities. In addition, individuals with seizures that are not controlled despite medication (refractory or intractable seizures) are at increased risk for intellectual disability.

Many childhood epilepsies are considered ‘benign’ because they are not associated with cognitive impairments and patients can grow out of them; more recent research has found mild cognitive deficits in these patients. In contrast, cognitive deficits, particularly involving memory, language, attention, problem solving and motor speed are often adversely affected in individuals with symptomatic epilepsies (that is, epilepsy associated with underlying neuroanatomical or neurophysiological abnormalities).

Temporal Lobe Epilepsy (TLE) is a common type of intractable epilepsy. It is often associated with mild impairments in memory along with language, reasoning, problem solving, visual-spatial and motor speed. These are usually detected by formal neuropsychological testing, which is part of the evaluation for possible epilepsy surgery.

Increased seizure frequency is also associated with cognitive dysfunction. The more frequent the seizures, the more likely there is to be associated cognitive impairment. As such, it is important to gain control of seizures quickly. Individuals who have their epilepsy successfully treated can have improved intellectual functioning and memory.

Seizure control typically starts with medication. There are many medicines approved for treating epilepsy. While cognitive slowing and mild reductions in attention and memory are common with the older medications, the more modern medications are generally less likely to have a negative impact on cognition. Most of the newer medications have neutral or beneficial effects on cognitive functioning. With good seizure control obtained from medication, individuals can experience an improvement in cognitive functioning.

The course of cognitive dysfunction in TLE and memory deficits in particular is an area of intense research. Interestingly, cognitive deficits and memory loss have been found for children with a variety of epilepsy syndromes, suggesting cognitive dysfunction is present at time of seizure onset. In fact, some research suggest cognitive deficits involving attention problems and learning disorders are present in some children before a first seizure is recognized. Individuals with ongoing seizures in adulthood are at increased risk for increasing memory deficits and, in some cases, intellectual deficits. With good seizure control, individuals may be at less risk for experiencing cognitive decline.
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