Transitory cognitive impairment

A number of papers describing this phenomenon have been published by Binnie and coworkers (Aarts et al., 1984; Marston et al., 1993). The basic concept is that an epileptiform discharge that does not appear, on simple observation, to be manifesting as a seizure, may nevertheless cause a transitory impairment of cognitive function. It has been shown that discharges on the left side may impair language function and on the right side may impair visuo-spatial skills. The quality of the impairment is not always straightforward. For example, a child who is having epi-

(a) Overt seizures in 3 months

(b) Spike-wave events in 24 hours

o 60

E 40

(a) Overt seizures in 3 months

(b) Spike-wave events in 24 hours

o 60

E 40

Baseline

4-6 Months

Baseline

4 6 10 32 48 Weeks

Figure 6.2. The effect of lamotrigine administration on number of overt seizures (a) and spike-wave events (b) experienced by Subject B.

Baseline

4-6 Months

Baseline

4 6 10 32 48 Weeks

Figure 6.2. The effect of lamotrigine administration on number of overt seizures (a) and spike-wave events (b) experienced by Subject B.

leptiform discharges during reading may pause or may read even more quickly but make additional mistakes when discharges are occurring.

Binnie and his co-workers have shown that reduction of epileptiform discharges can result in improvement of psychosocial functioning (Marston et al., 1993), although this study was confounded by the fact that obvious seizures were improved as well as the discharges causing the transitory cognitive impairment. Observation of video tapes taken during testing of young people who have transitory cognitive impairment leaves no doubt about the fact that they find their lapses in performance irritating and frustrating. It is highly likely that this phenomenon affects self-esteem and self-confidence. This implies that, although the phenomenon itself is transitory, there may be an ongoing negative effect on the attitude and behaviour of the individual.

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