Memory Impairment in Epilepsy: A Comprehensive Review of Structural and Pharmacological Influences.

Epilepsy affects 50 million people worldwide and is frequently associated with memory impairment, contributing significantly to reduced quality of life. Memory difficulties are commonly reported across epilepsy syndromes and may coexist with anxiety, reduced self-esteem and social withdrawal. While temporal lobe epilepsy is often highlighted due to the crucial role of mesial temporal structures in memory processing, memory functions also rely on distributed neural networks extending beyond the temporal lobe. A common concern among patients with epilepsy, discussed during clinic visits, relates to memory deficits. They often inquire if these deficits are linked to anti-seizure medications (ASMs), controlled or uncontrolled epilepsy or the underlying cause of their condition. It is crucial for the treating physician to understand the types of memory, the brain structures and circuits involved and how epilepsy, ASMs, structural brain lesions and neuromodulatory interventions affect the processes of acquiring and encoding memory. In this paper, we provide a brief yet clinically relevant overview of memory and the factors contributing to memory deficits. This publication is intended for both general physicians and specialists who care for patients with epilepsy and other neurological disorders. While previous studies suggest that epilepsy can affect memory, other contributing factors must also be considered. This paper will explore the fundamentals of memory, the effects of brain lesions and how treatments such as ASMs, ablative procedures, resective epilepsy surgery and neuromodulatory devices influence these processes. It also discusses cognitive rehabilitation and strategies to help patients cope with memory deficits and highlights areas for future research.