Treatment of state-dependent learning disability.

Abstract

It is important to distinguish between permanent learning disability on the one hand and state-dependent learning disability on the other (1). The concept of permanent learning disability is a familiar one. Brain damage or dysfunction from a variety of causes can result in permanent intellectual impairment. State-dependent learning disability is less widely recognised as an important phenomenon in people with epilepsy. This is learning disability that depends on the state of the individual at that time; antiepileptic medication (AEDs) or the epilepsy itself may be affecting the person at a particular time in a way that is not necessarily permanent. Why should treatment be considered? Because statedependent learning disability is potentially reversible, and the consequent improvement in cognitive function may result in a significant improvement in quality of life. To put the case more strongly, a doctor might be considered as being incompetent if he or she failed to recognise and treat state-dependent learning disability, in view of the fact that correct treatment can result in such a significant improvement in the life of the individual. In some cases, the treatment might be to reduce medication, whereas in others, if the epilepsy itself is affecting cognition at the time, it may be necessary to provide alternative or additional antiepileptic treatment in the form of medication or surgery. The first step in managing statedependent learning disability is to think of the diagnosis. Regrettably, this possibility is often not considered, and the patient goes untreated.