Can telerehabilitation deal with cognitive disturbances in epilepsy?
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LETTER TO THE EDITOR
Can telerehabilitation deal with cognitive disturbances in epilepsy? Anna Rita Giovagnoli 1 Received: 31 May 2020 / Accepted: 19 September 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Editor, More than 50% of adult patients with epilepsy suffer cognitive disturbances. The phenotyping of temporal lobe epilepsy (TLE) puts in evidence selective memory impairments or memory impairment associated with lexical, attentive or executive deficits [1], while an involvement of higher-order control functions seems to characterize frontal lobe epilepsy [2]. These disturbances may be independent of seizures and antiepileptic drugs, may precede seizure onset and may persist after seizure control and end of treatment. Moreover, 27–64% of patients with TLE show cognitive decline in a few years [3]. In contrast, there are few randomized, controlled or observational studies of cognitive rehabilitation in epilepsy [4]. This may depend on the prominent or exclusive importance given to seizures management and the few hospital structures dedicated to the treatment of cognitive disabilities in epilepsy. Indeed, most of the clinical and research resources are dedicated to seizure control. Additional reasons for poor application of cognitive rehabilitation may be the variability of the deficits over the course of the disease, poor patients’ motivation to be engaged in this treatment, low self-efficacy and limited access to the hospital consequent to fear of unexpected seizures or incapacity to move due to lack of driving license, public transport or help from other people. Such a situation is in stark contrast to dementia, brain injury or tumour conditions where cognitive rehabilitation has been applied for a long time [5]. In this framework, the question arises whether telerehabilitation can help to face the cognitive disturbances in epilepsy. Telerehabilitation has been developed a few decades ago aiming to overcome practical problems, such as a patient’s difficulty to reach the hospital, the lack of specialized centres in a patient’s place of residence, excessive costs of hospital management and incongruent timing of patients’ and health professionals’ activities. The need for intensive or * Anna Rita Giovagnoli [email protected] 1
Department of Diagnostics and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
prolonged treatments not feasible in hospital, the planning of home exercises and the need to address cognitive impairment in real life have also posed indication for telerehabilitation, providing prolonged benefits to patients with neurodegenerative diseases [6]. Recently, the use of telemedicine has become more and more important to public health due to coronavirus pandemic stimulating different telecommunication and digital technologies for cognitive, behavioural and psychological therapies. As for epilepsy, telemedicine may contribute to surpass some limits of hospital rehabilitation. Cognitive stimulation and training in a comfortable home spa
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