Cognitive rehabilitation

This article outlines the features of cognitive rehabilitation in epilepsy.

As we have learned so far, epilepsy might affect memory, language, attention, executive functions (e.g., planning and set-shifting abilities) as well as social cognition. These cognitive deficits contribute to the daily life distress caused by the disorder. However, the affected cognitive domains can undergo cognitive rehabilitation.

Epilepsy is a complex neurological disorder characterized by various seizure types, different levels of severity, and comorbidities. All of these aspects must be taken into account when planning a rehabilitation programme. The prognosis of the disorder must also be considered, so that the effects of the training can be anticipated and monitored. For example, recurring epileptic events may reduce the benefits obtained.

The side effects of antiepileptic drugs are another important factor that a neuropsychologist has to bear in mind when planning an intervention. In line with these premises the training has to be tailored on the specific needs and wishes of the patient and on his/her neuropsychological profile. This is called “individualized training”. It is essential that a rehabilitation programme includes also some sessions of psychoeducation in order to make the patient sufficiently aware of his/her cognitive deficits and their impact on everyday activities. In this way, the patient’s awareness of the disorder is improved and the response to rehabilitation programmes strengthened. Involving the patient’s family is crucial for the positive outcome of the whole training.

The case of Alice: cognitive rehabilitation

Alice underwent two different cycles of rehabilitation. The first comprised 10 sessions of computerized training through CogniPlus, a tool distributed by the Schuhfried company. The purpose of the exercises was to improve working memory, selective and divided attention, and language. The second cycle was made up of 15 sessions of computerized exercises (more complex than the previous ones) and trained activities carried out in the real world (e.g., how to send a letter, go to the bank, plan a holiday).

This rehabilitation programme had positive effects on memory updating and planning. In general, Alice’s self-efficacy was improved, but she still showed a low level of attention and a general slowdown, probably due to a few recurrent seizure events during the training.

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