CHAPTER 7 Summary and Conclusions

Introduction: Epilepsy is a common neurological disorder affecting over 50 million people worldwide. Neuropsychological deficits are mainly in areas of attention, memory, reasoning and psychomotor ability. The etiology of these deficits is three fold: 1. Underlying disease process which is causing the seizures; 2. Brain damage caused by seizure; 3. Anti epileptic drugs which leads to decline of cognitive functions. The present study used the method of cognitive remediation to epileptic patients to ameliorate rather improve these deficits in various sphere thus improving the quality of life. Aim: The aim of the study was to see the impact of cognitive remediation on cognitive functioning and on quality of life of epileptic patients. Sample: Epileptic patients who complained of cognitive deficits as seen in Neuropsychological battery and were between 18-45 years with minimum of primary level of education, seizure free for at least for 3 months before the program with no history of neurological illness major psychiatric illness mental retardation and substance abuse and no history of symptomatic epilepsy were included in the study. Page 173

Methodology: Epileptic patients who gave consent for the study were 46 in all after obtained informed consent. 16 people dropped out and out of 30 people who underwent cognitive assessment 15 were placed in the treatment group and 15 in the control group. The treatment group was given the cognitive remediation program and after the completion they were again given tests for post therapy assessment. The control group was called after one month and again assessment was done where no remedial measures were given. The cognitive remediation program was increased as the patient reached the plateau level. The complexity of the task was increased. Initially in the cognitive functioning Attention, and information processing, was improved and after it the higher order functions improved. The patients were motivated to carry on the test. Results: Epileptic patients had cognitive deficits. They had problems in psychosocial areas as seen in Quality of life scales. Epileptic patients who constituted the treatment group underwent remedial measures showed significant improvement in cognitive functioning and quality of life variables. Discussion: The cognitive recovery can be studied under neural plasticity and cognitive plasticity. Neuronal plasticity underlies the biological/structural basis of cognitive recovery. Cognitive plasticity Page 174

mediates the psychological/functional basis of cognitive recovery. Under the biological standpoint, activity dependent processes in cortical plasticity, is an important explanation for the effects of cognitive retraining. Cognitive plasticity has explained the improvement in various facets of cognition during retraining, using a general model of cognitive functioning in epilepsy. The association between improvement in cognitive functions and psychosocial functioning was explained by the “data driven” and “theory driven” effects of cognitive retraining, using the social information processing theory. Conclusions: It can be concluded that the cognitive remediation program has lead to improvement in cognitive functions, decrease in subjectively felt symptoms and improvement in psychosocial areas of functioning. Mere passage of time did not show any improvement on these areas.

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