This text-based course is a transcript of the webinar, Vanderbilt SLP Journal Club: Seizure Disorders and the Effects of Antiepileptic Medications on Cognitive-Communicative Functions, presented by Rima Abou-Khalil, PhD, CCC-SLP.
Learning Outcomes
- After this course, participants will be able to describe the difference between seizures and epilepsy.
- After this course, participants will be able to describe the complexity of seizure classification and treatment.
- After this course, participants will be able to list 2-3 cognitive and linguistic effects of antiepilepsy drug (AED) treatments.
Introduction
Thank you for this opportunity to share some research on this very interesting topic. Today’s course will discuss the following:
- Definition and classification of seizures
- Definition and treatment of epilepsy
- Epilepsy and cognition
- Antiepileptic drugs (AEDs) and their effects on cognition
- Topiramate (TPM) as an example of an AED with negative cognitive effects
- Levetiracetam (LEV) as an example of an AED with possible positive effects on cognition
Why Should SLPs Care About this Topic?
We tend to work with neurogenic populations. Any kind of neurological damage increases a patient’s risk for seizures. Currently, the standard is that a person with TBI in the acute setting is immediately given Topiramate (a.k.a., Keppra) or Levetiracetam which is one of the medications that will be discussed later. Keppra is used with acute TBI patients to help with prevention of seizures. A recent study found that about 4% of people with cortical strokes would develop seizures eventually. Many stroke patients, particularly if they're cortical stroke patients, are also given antiepileptic drugs. Even with antiepileptic drugs used in the initial stages, some patient are going to develop epilepsy or seizures. They will remain on antiepileptic medication for a while. They come to us in inpatient and outpatient settings on these medications. Therefore, it's important for us to understand what they are going through.
Seizure Definition
Seizures are defined as transient signs or symptoms due to abnormal excessive or synchronous neural activity in the brain. This definition was generated by the International League Against Epilepsy (2014). The most important words are transient because a seizure has a finite beginning and a finite end and synchronous which means that it doesn't have to manifest as a clinical sign or symptom. It just has to be abnormal activity in the brain.
Seizure Classification
Clinically, seizures can have many different presentations. They are pretty challenging to classify so we're going to look at seizure classification at a simple level.
Partial
Seizures are classified as being focal (aka, partial). Focal seizures are those that begin within one hemisphere. They are considered to be simple if consciousness is not affected and complex if consciousness is affected. If the seizure begins in one hemisphere and consciousness is preserved, it's called a simple focal or simple partial seizure. If it begins in one hemisphere and consciousness is altered, then it's considered to be a focal complex seizure.
