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Cognitive Rehabilitation to reduce post-stroke epilepsy risks

Stroke transforms life within a beat. In addition to the shorter-term problems, such as weakness, loss of speech, and emotional fluctuations, there is a danger that may arise weeks or even months after the stroke. It is called post-stroke epilepsy.

However, this is not without any good news; new evidence demonstrates that cognitive rehabilitation may be a very strong tool both in assisting the brain to heal, as well as in preventing post-stroke seizures.

Let’s explore how.

Theories on the Relationship between Stroke and Epilepsy.

A stroke happens when the blood supply to some part of the brain is blocked, resulting in damage to brain cells. The effects may be physical disability, or may be changes in memory, thinking, and behavior, depending on the area and extent of the injury.

The death of the brain cells results in hyperactivity or irritable tissue – a form of electrical disequilibrium in the brain. This damaged area may, over time, develop into the initiator of seizures, resulting in what is known by doctors as post-stroke epilepsy (PSE).

The studies indicate that 5 to 15 percent of individuals who do not die after having had a stroke develop epilepsy, with the highest being in the first and second year.

Some aspects contribute to this danger:

• Serious strokes or bleeding strokes in the brain (hemorrhagic stroke).
• Cortical involvement – in case the outer layer of the brain is involved.
• An earlier age at the time of stroke.
• Reactive strokes or rehabilitation lag.

Yet as much as medication can control the seizures, prevention and recovery of the brain begins much earlier, and that is rehabilitation. And of the various treatments that one can take, cognitive rehabilitation is becoming an important one.

What Is Cognitive Rehabilitation?

Cognitive rehabilitation is an intervention that aims at healing or making up the mental functions that might be impaired by stroke. These include:

• Concentration and attention.
• Memory
• Problem-solving
• Reasoning
• Executive function (planning, organizing, and time management skills)

It entails the use of organized, purposeful practices, which, in most cases, are facilitated by neuropsychologists, occupational therapists, and physiotherapists to retrain the brain in terms of how it thinks and communicates.

However, the best thing about cognitive rehabilitation is neuroplasticity, which is the natural capability of the brain to rewire itself.

Therapy promotes the healthy brain cells to establish new connections by repeatedly stimulating targeted regions through specific tasks, thus minimizing the abnormal electrical activity, which would otherwise cause seizures.

How Cognitive Rehabilitation Helps Prevent Post-Stroke Epilepsy

1-Restoring neural pathways

Following a stroke, the brain attempts to circumvent its functions to other regions that survive. Nevertheless, incomplete recovery can result in the malfunctioning of those damaged networks whose conduct is unpredictable.

Cognitive therapy assists in sorting and reinforcing these neural connections by means of systematic mental activities.

For instance:

• Exercises of the memory promote the reorganization of the synapses.
• Cortical synchronization is enhanced by attention training.
• The task that involves problem-solving promotes communication between the brain hemispheres.
• Combined, these activities stabilize the brain activity and reduce the risk of erratic brain firing that causes seizures.

2-Lessening the psychological and emotional stress.

Post-stroke patients commonly display anxiety, frustration, or depression as they fight to take charge of their lives.

Cognitive rehabilitation does not merely reconstruct the thinking abilities but also makes individuals gain confidence, enhance the emotional regulation process, and reconstruct their purpose.

Mindfulness, relaxation training, and coping strategies are usually combined during the sessions with therapists. The practices reduce the physiological states that predispose to seizures because they reduce stress and emotional reactivity.

3-Enhancing efficacy in medication adherence and self-management.

The recovery process after the stroke may be confusing; there are a lot of medications, therapy sessions, changes in the diet, and follow-ups, all of which may make the patient overwhelmed.

The cognitive decline complicates the process of remembering or comprehending treatment regimes and unintentionally results in either missed doses or a lack of control over the seizures.

This is addressed with cognitive rehabilitation, which is aimed at improving:

• Recalling (remembering when to take drugs).
• Organizing and planning (maintaining therapy appointments).
• Knowledge and perception (becoming aware of warning signs of seizures).

Therapy indirectly improves the quality of life and the prevention of seizures by empowering patients to be in control of their health.

4-Improving sensory and motor synthesis.

Cognition and motor control are closely intertwined, as the brain does not operate alone.

Cognitive rehabilitation, when combined with physiotherapy and occupational therapy, enhances the coordination of the entire brain.

For example:

Frontal and motor areas are both stimulated by dual-task exercises (walking and recalling words).

Visual-spatial training assists the patients to interpret environmental information in a better manner, where the patient becomes less disoriented or stressed.

This re-education as a whole rejuvenates more harmonious and predictable cognitive processes – a condition that is less likely to release an epileptic outburst.

5-Promoting sleep and circadian rhythm.

Another significant cause of post-stroke seizures is sleep disturbances.

Sleep hygiene education is often part of the cognitive rehabilitation process, and it aids the patients in regaining regular rhythms. In conjunction with relaxation strategies and environmental modification, it enhances restorative sleep, which normalizes neuron functioning and minimizes the vulnerability to seizures.

Fundamental Building Blocks of Cognitive Rehabilitation in Stroke Management.

The effective cognitive rehabilitation program usually consists of the following components:

Evaluation and individualization.

No two strokes are alike. The neuropsychological tests administered by the rehabilitation team enable the team to learn the cognitive strengths and weaknesses of each patient.

The therapists then design an individualized plan that has attainable, realistic objectives.

Targeted exercises

A combination of computer-based training, puzzles, reading comprehension, sequencing exercises, and memory recall games is used to stimulate affected regions by therapists.

Group therapy

Communication is an essential element of curing. Group sessions promote communication, collaboration, and empathy, which reduces isolation, which is one of the major determinants of emotional stability and brain health.

Environmental and lifestyle modifications.

Therapists help patients and families in the development of supportive environments:

• Structured daily routines
• Clutter-free surroundings
• Less exposure to the screen before bedtime.
• Sufficient nutrition and hydration.

Education of the family and the caregiver

The empowered families end up being active participants in seizure prevention and are educated by the therapists to create a conducive environment for optimum recovery.

Indications of when to initiate cognitive rehabilitation.

Early intervention is key. Cognitive therapy ideally commences when the patient is stable medically, which in most instances is in weeks after the stroke.

There are huge results with therapy, even when it is initiated later on- as long as the programs are regular, adaptive, and holistic.