Can Exercise Improve Memory In Epilepsy? - Dr. Jane Allendorfer, University of Alabama at Birmingham, AL, USA
Can exercise improve memory in people with an epilepsy? Assoc. Prof. Jane Allendorfer explores how physical activity may drive measurable changes in verbal learning, memory function, and hippocampal connectivity! Building on a 6-week pilot study showing improved memory performance, we hear about her newly completed randomised clinical trial investigating exercise for memory rehabilitation in epilepsy, aiming to determine whether changes in brain networks can explain cognitive improvement and help predict who will benefit from intervention.
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Episode Highlights
6-week exercise intervention improved verbal memory performance
Early data links memory gains to hippocampal connectivity changes
New randomised trial tests exercise for memory rehabilitation in epilepsy
Analysis underway to predict who benefits from exercise interventions
About Jane Allendorfer
Jane B. Allendorfer earned her Ph.D. in Neuroscience in 2009 and completed post-doctoral training at the University of Cincinnati. She joined the University of Alabama at Birmingham Department of Neurology faculty in 2012 and is currently a tenured Associate Professor. She is the Co-Director of the Civitan International Neuroimaging Lab/Research MRI Core and an Associate Director of the Neuroscience Roadmap Scholars Program. She has over 20 years of experience conducting neuroscience and magnetic resonance imaging (MRI) research in healthy and patient populations and has published over 100 peer-reviewed publications. The goals of her current research are to apply strategies for improving the quality of life of individuals with epilepsy and other neurological disorders as well as healthy individuals. She also utilises non-invasive brain imaging methods to better understand how disease-modifying factors, including physical exercise, exert their positive effects. Her goal is to leverage this knowledge to improve health, cognition, mood, and overall quality of life in healthy and neurological populations.
Full profile: Jane-Allendorfer
Topics mentioned
memory impairment
verbal learning
hippocampus
functional connectivity
exercise intervention
endurance & resistance training
idiopathic generalised epilepsy
cognitive rehabilitation
Related papers
A pilot study of combined endurance and resistance exercise rehabilitation for verbal memory and functional connectivity improvement in epilepsy, Epilepsy & Behavior, file:///C:/Users/torie/Downloads/Jane%20Allendorfer%20papers/Allendorfer_etal_EpiBehav_2019_endurance+resistance_training_in_epilepsy.pdf, Jane B. Allendorfer et al, May 2019, PMID: 31078935, DOI: 10.1016/j.yebeh.2019.04.020
The relationship between physical activity and cognitive function in people with epilepsy: A systematic review, Epilepsy & Behavior, file:///C:/Users/torie/Downloads/Jane%20Allendorfer%20papers/Alexander_Allendorfer_EpiBehav2023_Epi_cognition_exercise_Review.pdf, Halley B. Alexander, Jane B. Allendorfer, May 2023, PMID: 36940504, PMCID: PMC10173358, DOI: 10.1016/j.yebeh.2023.109170
Do people with epilepsy want to participate in an exercise intervention randomized controlled trial? – Results of a brief survey and its preliminary application, Epilepsy & Behavior, file:///C:/Users/torie/Downloads/Jane%20Allendorfer%20papers/Mitchell_etal_EBR2023_exercise_survey_in_PWE.pdf, Brandon S. Mitchell et al, Nov 2023, PMC10665809 PMID: 38025406, DOI: 10.1016/j.ebr.2023.100632
Report
Advancing Physical Activity and Exercise Research in Epilepsy, Epilepsy & Behavior, https://www.sciencedirect.com/special-issue/102DLVCP77P, Jane B. Allendorfer, Jul 2023.
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Trailer
00:00 Jane Allendorfer
So, there is a very particular brain region called the hippocampus that is important in memory function. And we were very interested to see how its connections to other parts of the brain would change with exercise! And so, in the pilot study, we saw that, you know, its change in this connect the hippocampus connection was associated or related to their improvement in memory function! And so, in this larger trial, we are really looking to test that. Is it because of the changes in these functional connections with other brain regions? Is that what is driving these improvements in memory improvement in people with epilepsy.
Intro
00:46 Torie Robinson
Welcome to Epilepsy Sparks Insights. I’m your host, Torie Robinson, and today I’m joined by Associate Professor Jane Allendorfer, who is going to be sharing with us how exercise may improve memory in people with an epilepsy! Up to half of people with an epilepsy report cognitive difficulties - particularly memory - even when their seizures are controlled. So today, we are exploring early evidence from a pilot study involving a structured exercise intervention which has shown measurable improvements in memory over just six weeks(!) - with brain imaging data suggesting positive changes in hippocampal connectivity! We will also talk about Jane’s latest randomised clinical trial — and why this could shift how we think about memory rehab in epilepsy!
If you’re new here, please subscribe so you don’t miss future conversations - and let’s get into today’s episode.
Top cognitive complaint in epilepsy
01:31 Jane Allendorfer
In other disorders and neurological disorders, exercise has been utilised as, a complementary therapy to help enhance cognitive function, particularly memory function. And when I started looking at the epilepsy research, I didn't see much of that. Up to half of the patients with epilepsy have cognitive complaints, and that doesn't know, rely on whether or not they're seizure free. The top cognitive complaint is actually memory function.
02:04 Torie Robinson
Hmm, interesting. And we were speaking a bit about this beforehand. And you know, you gave me a great example of somebody who was a top-shot lawyer and with his epilepsy, despite how his performance appeared to other people - he could still tell that his cognitive function was impaired by his epilepsy.
02:23 Jane Allendorfer
Absolutely, and this person tested above average on all of the cognitive assessments that were part of the study. But then when asked, you know, whether or not they feel like epilepsy or seizures have affected their cognitive function, they're like “Absolutely, I am not at the level where I was before. And if something can help improve that, I'm willing to do it.”. And so, they were actually part of the pilot study that I had years ago.
Endurance and resistance training programme
02:54 Torie Robinson
So, tell us about this pilot study then. What was it called and what did you do?
02:57 Jane Allendorfer
So, it was a combined endurance and resistance training programme, it was a very short six-weeks. Most exercise intervention studies are actually 12-weeks or longer, but I wanted to just see if there was a signal with respect to, you know, a change in memory before and after exercise. And then also, you know, people with epilepsy; it's hard to get them in multiple times! And so, I wasn't sure if we could get them in for 12 weeks. I figured if we can get them in for 6-weeks and see a signal with respect to memory, you know, that's a plus. And also, because it is combined endurance and resistance training at a moderate intensity. You know, a lot of people with epilepsy are not very active and so being able to actually just get them in and do the intervention itself, which show feasibility. So, we were able to do that with a small set of patients. About eight or nine of them were able to do the intervention and then we had another eight that were a control group that didn't do the intervention. It was just six-weeks of their everyday activities.
04:14 Torie Robinson
Just to clarify for all our listeners, are we talking people who kind of have average IQ, people with a degree of intellectual disability, people who are all like the lawyer that you mentioned? Do they have many comorbidities?
04:26 Jane Allendorfer
We didn't exclude based on seizure freedom, so, we took them, whether or not they were seizure free. A lot of the studies actually focus on people who are not seizure free when it comes to exercise. And because memory impairments affect all people with epilepsy, that wasn't exclusionary for us. It's just whether or not they thought they had memory issues due to their epilepsy or antiseizure medications or seizures themselves. We did not take people with intellectual disability because we want to have somewhat of a normative baseline when it comes to that. However, we didn't do any kind of neuropsychological testing beforehand to include or exclude them, it was literally just the question, “Do you feel that you have memory impairments due to your epilepsy?”
05:25 Torie Robinson
So what was the outcome of that study? What did you learn?
The exercise improved verbal learning and memory function
05:27 Jane Allendorfer
So, what we learned was that people who did the exercise improved in their verbal learning and memory function. So, in a relatively short period of time, there was a significant improvement in how they recognised words after they've learned it. So you learn a list of words, there's about a 30-minute delay, and can you recognise it, you know, later on. And the people who didn't exercise actually had a decrease in that performance, which was, I thought was amazing for just a 6-week time period. And we were also able to look at an individual level, you know, what that looked like. Because sometimes when you look at group, comparisons…
06:21 Torie Robinson
Mmm.
06:21 Jane Allendorfer
…everything gets averaged out. And you have to question, what's really happening. And when we looked at each individual, those who exercised, either they maintained, you know, their performance or they improved. And those who didn't exercise, you could see the decreases. It's nice to know that like with even a short intervention like that, people can maintain their function or improve it.
Improved brain connections due to exercise
06:47 Torie Robinson
Tell us about the brain imaging part - which is kind of important in order to see how people's brains have changed or modified in the process of the exercise.
06:54 Jane Allendorfer
So, there is a very particular brain region called the hippocampus that is important in memory function. And we were very interested to see how its connections to other parts of the brain would change with exercise! And so, in the pilot study, we saw that, you know, its change in this connect the hippocampus connection was associated or related to their improvement in memory function! And so, in this larger trial, we are really looking to test that. Is it because of the changes in these functional connections with other brain regions? Is that what is driving these improvements in memory improvement in people with epilepsy? I'm really excited to be able to see what those results are after we've analysed the data. But, you know, I think our brain's ability to change is so important because it helps us adapt. And what we're hoping is maybe if we can see what these connections are at the beginning of, say, an intervention, can we predict who's actually going to improve or not, you know, can we… is that a way to see who can respond to an intervention or not? And so that's why I'm really excited about that aspect of it as well.
Exercise for memory rehabilitation and epilepsy trial
08:21 Torie Robinson
What was this randomised clinical trial? What was that all about? And what's the title and all that?
08:26 Jane Allendorfer
It's called exercise for memory rehabilitation and epilepsy. It used the same exact intervention as in the pilot study (the combined endurance and resistance training at moderate intensity). And we had a control group that didn't exercise and a group that did exercise, so they were randomised to one or the other. We had wanted to recruit a lot more patients, but in the pilot study, we took all comers and in this randomised clinical trial, we took a subset of people with epilepsy (idiopathic generalised epilepsy). So, there's only about 20% of the epilepsy population that have this. But we focused in on them in general because actually in the pilot, the majority of those patients had idiopathic generalised epilepsy, so, we just took that. And also, for patients with this type of epilepsy, even though they comprise 20% of the population, only about 1% of research is conducted in this population. So, it's a bit disproportionate. So that's also part of the rationale for focusing on them.
09:45 Torie Robinson
What about recruitment? How many people did you have involved in the study? What were the dropouts (because there are always dropouts, like it's to be expected)? How did that go?
09:54 Jane Allendorfer
We had recruited 71 participants in total and we're still going through the numbers because we literally just unblinded last month! And so, I was not able to see a lot of the data. And so we're still sorting through that. Not everyone, of course, was able to complete the study in terms of the breakdown between those who exercised and did not exercise in that first 6-week period. We're still working through those numbers.
10:28 Torie Robinson
It's so interesting because I've been reading a lot lately about, you know, as a world, we're telling everybody that they need to do more exercise.
10:35 Jane Allendorfer
Yeah.
10:35 Torie Robinson
If you don't want to have heart disease or stroke or die early. But it's just so interesting that the more we learn (and I think this has been around ages, but it's not been promoted that well), is how exercise can improve cognitive function. And that's…
10:49 Jane Allendorfer
Absolutely.
10:49 Torie Robinson
And since that's a thing that's so, as we've already said, is commonly affected by people with an epilepsy, whether it's down to the seizures or whether it's down to the medication, or whether it's down to the psychiatric illnesses (which are part of it or come alongside it), it can be so…it's… we have such a need, but then also, you say the word “exercise” to people and many of us freak out!
11:12 Jane Allendorfer
Absolutely. Absolutely.
11:13 Torie Robinson
So how did you get over that in your work and how can we get over that as a species?
Exercise gets a bad rap
11:19 Jane Allendorfer
In general, I think, you know, exercise has a bad rap because you think of it as work, right?! And so, I think, moving forward, I'm looking at more just physical activity in general, because when you look at the statistics, people with epilepsy just aren't as physically active, whether that's exercise or non-exercise, right? Just…
11:45 Torie Robinson
Just movement.
11: 45 Jane Allendorfer
…activity, just movement in general. But I think, you know, being able to increase physical activity in people's leisure time, not because you have to be physically active for work, right? Because that's work! But something that you enjoy doing, you want to do, I think focusing in on that will be important. Whether or not just physical activity in general will help improve cognition and cognitive function or memory, that's still to be seen and we would need to look at that specifically, right? My studies were very specific on being moderate intensity. So, we want to get the heart rate up. We want to get the heart moving and the blood flowing to a certain level in order to sort of get a particular effect. And so, whether or not that's needed for this kind of improvement, I can't say because we didn't test that. But regardless, just being more physically active is better for quality of life, right?! And feeling better and mood. And we know this in other conditions,. Why it's not been so focused on in people with epilepsy; I there's a lot of things that go into that, as you know, you know, fear of seizures, fear of hurting yourself or, you know, just maybe even being embarrassed; there's a whole stigma against epilepsy.
Exercise fear, self-consciousness, and misunderstandings
13:18 Torie Robinson
I think a lot of the issues are the same as though for everybody else, aren't they? Like people without epilepsy are often scared to go and exercise or what they perceive to be exercise, or they don't want to be seen in the gym (and not that we have to go to the gym but that's what we're taught)...
13:32 Jane Allendorfer
Yes.
13:32 Torie Robinson
…and so I don't think it's just the people with epilepsy, it's humans in general, it's just that we are even more likely to not get the exercise that we need and more likely to have cognitive dysfunction and so could benefit from it potentially more than other people.
Exercise guidelines
13:47 Jane Allendorfer
Absolutely. And I think the lack of guidelines, know, clear guidelines, you know, is part of that, even though there was recommendations by the International League Against Epilepsy that were published with respect to, you know, level of physical activity and types of physical activities that are safe for people with epilepsy, especially if you're seizure-free. And if you're not, you know, in conjunction with your clinician, that you can be physically active still. I think that information isn't well advertised and even a number of clinicians that I know are not aware of those recommendations.
14:30 Torie Robinson
Oh gosh!
14:31 Jane Allendorfer
Yeah, so I think, you know, kind of spreading the information, not just to the patients and their family members or caregivers but also educating clinicians on what these recommendations are. And, you know, that was years ago, and so, I think updating them too, as more research comes out respect to effects of exercise and what's safe and it's going to be really important in the next few years.
Exercise can lead to fewer seizures
14:59 Torie Robinson
I completely agree. And, but you know what? think often we look at just, we look at one step. So, if you… some people are worried that understandably in many cases, if they exercise, they'll seize. But at the end of the day, for many people, if you exercise, reduce your seizure likelihood because you improve sleep, you improve mood, and those things alone can help to reduce seizure likelihood in many people!
15:22 Jane Allendorfer
Absolutely. So it's not a simple relationship, right? But exercise has full body effects, right. Your brain, your heart, your mood, and definitely with sleep. And so again, those are known in other conditions. I think maybe for people with epilepsy, they want to be shown that “This affects me too.”. And there's just so little research on that in general. A lot of the focus has been exercise and seizures, right? Is it seizure inducing? It's not even does it, you know, prevent seizures. Does it induce seizures? And you look at a lot of the literature, that's what it's been for a very, very long time. And I think we need to kind of shift the mindset with exercise and physical activity in people with epilepsy and start asking the question “What benefits can people with epilepsy gain specifically from that?”. So, if sleep is a huge part of your seizure control, how can it help you improve sleep? What if it's just walking, right? It doesn't have to be full on going to the gym, lifting weights, getting your heart rate up to like 120 or whatever! It's just take a walk for a half hour, right? Does that help improve? But we can't answer those questions specifically in people with epilepsy right now because people haven't asked the question!
Reading and questions for clinician and person with an epilepsy
16:53 Torie Robinson
Everybody listening, if you're a clinician/physician, ask your patients these questions; like how are they getting on and I think that we should all be getting together to do more studies like the one that you are analysing at the moment Jane, but also and then if you are a person with an epilepsy, bring it up with it, or if you don't want to bring it up quite yet with your clinician, then think, actually “Let me start recording this stuff myself!”. And you can sometimes see the correlations between things…
17:17 Jane Allendorfer
Yes.
17:18 Torie Robinson
…which may not be what you expect.
17:20 Jane Allendorfer
We're trying to grow the literature on exercise and physical activity in people with epilepsy. I understand, you know, it's hard to read some of that literature sometimes, but it is out there and there's open access ones that anybody can access without paying for. And I think, you know, talk to your, if you're a patient, talk to your clinician. If you're a caregiver, you know, talk to your person with epilepsy. Because I think support is important for being physically active and exercising. It doesn't matter who you are. If you don't have that kind of support system, it's very difficult to just do things on your own.
18:01 Torie Robinson
And there are different ways around it for different types of people. Some people don't like to be around others when they do it. Fine, you don't have to be. If you want to be around a load of other people, there are certainly options for that as well. And I know lots of people get worried about being judged when exercising, but again, there are ways around that. And at the end of the day, we want to improve our cognition. We do!
18:26 Jane Allendorfer
Absolutely.
Exercise is crucial for health
18:26 Torie Robinson
And so, there's a balance. Do we do a bit of exercise or do we see our cognition remain there and possibly lower? Or do we improve our physical exercise a bit and possibly see an improvement in cognition?
18:39 Jane Allendorfer
You don't have to go straight to exercise, right? Just get up, walk around, just be more active in general. One way to measure this is less time sitting. So right now, I am standing up as I as I do this podcast with you, you know, less sitting time can be a metric. So maybe that's a good starting point.
Closing thoughts & thanks
19:00 Torie Robinson
A true thanks to Jane for joining us and sharing her exciting results! Her latest randomised clinical trial has now been completed and unblinded, with analysis currently underway - so keep an eye out for her paper over the coming months.
In the meantime, this raises a practical question for both clinicians and people with an epilepsy - what may exercise actively improve, from memory to mood to overall quality of life, and how can we start integrating that into care in a more structured, evidence-based way?
If you enjoyed this conversation, please share it with a friend or colleague, and hit follow or subscribe so you don’t miss future episodes. See you next time.