SpeechPathology.com Phone: 800-242-5183

The Speech Pathology Group - You'll Be in Good Company - September 2020

Temporal Lobe Epilepsy and Cognition

Rima Abou-Khalil, PhD, CCC-SLP

September 30, 2016



How does temporal lobe epilepsy impact cognition? 


Temporal lobe epilepsy is the most common form of epilepsy.  It is well studied and the deficits in temporal lobe epilepsy are well known. Seizures often begin in the hippocampus which is responsible for memory. If it begins in the dominant hippocampus, there will be verbal memory impairments and in the non-dominant hippocampus, visual spatial memory might be affected.  The earlier the onside of temporal lobe epilepsy, the greater the memory impairment.

Then, not surprisingly in epilepsy populations, depression is a common co-morbidity. Depression and epilepsy together affect memory even more than if the person didn't have a co-existing depression.

Other cognitive deficits with temporal lobe epilepsy may include IQ, executive functioning and language. With dominant temporal lobe epilepsy, impaired naming is a common co-morbidity.

Another problem with temporal lobe epilepsy is that the earlier the onsite, particularly if the onset is in childhood or in infancy, the greater the likelihood of cerebral reorganization for language. Patients with early onset temporal lobe epilepsy of the dominant lobe tend to have atypical language distributions. They may either have bilateral language distribution or the language might shift entirely to the intact non-dominant side. This shift to the right hemisphere is associated with deficits of its own, particularly in non-verbal language. The organization's not considered to be extremely beneficial in temporal lobe epilepsy of early onset.

Cognitive disturbances in epilepsy are not static. They tend to get transiently worse after a seizure. A person who has a seizure can have a period of time called the “post ictal period”, which is characterized by the ending of the clinical seizure. The person is no longer shaking or trembling. However, the electrical activity continues to be impaired in the brain.  During that post ictal period, there can be post ictal aphasias, particularly if the epilepsy is generated in the dominant temporal lobe.

Electrical disturbances can occur without clinical manifestations and they can cause transient impairments. The expectation is that the anti-epileptic drug will improve cognition by reducing the impact of the seizure. The AEDs will improve cognition because they lower these transient impairments. Therefore, the person should be able to recover cognitively sooner rather than later.

Rima Abou-Khalil received her Ph.D. from Vanderbilt University in 2003.  She is currently a faculty member at Vanderbilt University with clinical and research interests in acquired neurogenic disorders. 

rima abou khalil

Rima Abou-Khalil, PhD, CCC-SLP

Rima Abou-Khalil received her Ph.D. from Vanderbilt University in 2003.  She is currently a faculty member at Vanderbilt University with clinical and research interests in acquired neurogenic disorders. 

Related Courses

Behavioral Frameworks for Dementia Management
Presented by Mary Beth Mason, PhD, CCC-SLP, Robert W. Serianni, MS, CCC-SLP, FNAP


Mary Beth Mason, PhD, CCC-SLPRobert W. Serianni, MS, CCC-SLP, FNAP
Course: #9473Level: Intermediate1 Hour
  'A very clear, precise presentation presented by knowledgeable presenters in the field'   Read Reviews
This course will focus on cognitive-communication intervention strategies for various dementia presentations and will provide a review of evidence-based treatment. Behavioral frameworks along with their rationales will be introduced and applied across several dementia types and mild, moderate and severe levels of impairment.

Assessment of Cognitive-Linguistic Skills: The SLP's Role in Acute Care
Presented by Lisa Mechler, MS, CCC-SLP


Lisa Mechler, MS, CCC-SLP
Course: #8194Level: Introductory1 Hour
  'Very practical suggestions were made for evaluation and treatment'   Read Reviews
This course will review the rationale for completing cognitive-linguistic evaluations with adults in the acute care setting. Informal and formal assessments will be reviewed, as well as the role of the SLP in a multidisciplinary team.

Person-Centered Care 101 for Neurogenic Disorders
Presented by Sarah Baar, MA, CCC-SLP


Sarah Baar, MA, CCC-SLP
Course: #8475Level: Introductory1 Hour
  'Great ideas, organized presentation'   Read Reviews
Person-centered care is emphasized as a best practice in general health care as well as speech-language pathology. This course is an introduction for SLPs treating adults, to show how simple choices for each step of the clinical process can lead to a person-centered approach and highly meaningful, functional therapy.

Post-Acute Care: Payment Reform and Alternative Payment Models
Presented by Renee Kinder, MS, CCC-SLP, RAC-CT


Renee Kinder, MS, CCC-SLP, RAC-CT
Course: #8227Level: Intermediate1 Hour
  'It's important and complex information, but the questions on the assessment are too easy'   Read Reviews
Alternative Payment Models, known as APMs, are alternatives to traditional fee-for-service reimbursement. This course will explore current payment reform structures and the impacts on post-acute care of moving from volume-based fee-for-service models to outcomes-based reimbursement.

Vanderbilt SLP Journal Club: The Role of Hippocampal Memory in Language Use and Language Disorders
Presented by Melissa Duff, PhD, CCC-SLP


Melissa Duff, PhD, CCC-SLP
Course: #8230Level: Advanced1 Hour
  'We really got down in the weeds with this one'   Read Reviews
This course will review evidence for hippocampal contributions to language use and processing. We will also discuss the implications of this work for understanding cognitive-communication disorders in TBI and Alzheimer’s disease.