Memory weakness and epilepsy

William Barr, PhD, ABPP. Reviewed By: Joseph I. Sirven, MD (March 19, 2014). Types of Memory Problems. Epilepsy Foundation of America.

  • “Problems of attention and encoding” – information fails to become memory
  • “Problems of storage” – retention
  • “Problems of retrieval” – recall

Irene Elliott, RN, MHSc, ACNP and Janice Mulligan, MSW, RSW. How Epilepsy Affects Learning. (2/4/2010). AboutKidsHealth, The Hospital for Sick Children. Canada.

memory: a child may study a topic many times, but not remember it the next day



Diet and Epilepsy

Modified Atkins Diet

Modified Atkins Diet Can Cut Epileptic Seizures in Adults. (28 Jan 2008). Johns Hopkins Medicine. [Bold words my addition]

In 2002, Johns Hopkins researchers began testing a modified version of the Atkins diet in children with epilepsy… modified diet… high-fat focus of the ketogenic diet, prompting the body to generate ketones… allows more carbohydrates and protein, doesn’t limit fluids and calories, and has no fasting period… began testing it for efficacy and ease of use in adults.

30 adults with epilepsy, ages 18 to 53 years, who had tried at least two anticonvulsant drugs without success and had an average of 10 seizures per week, were placed on the modified Atkins diet… restricted them to 15 grams of carbohydrates a day. “… a few strawberries, some vegetables, or a bit of bread,”… most of its calories from fat-eggs, meats, oils and heavy cream-with as much protein and no-carb beverages…

…about half the patients had experienced a 50 percent reduction in the frequency of their seizures by the first clinic visit. About a third of the patients halved the frequency of seizures by three months. Side effects linked with the diet, such as a rise in cholesterol or triglycerides, were mild. A third of the patients dropped out by the third month, unable to comply with the restrictions… diet won’t be a good fit for all patients


Katie Barwick, Senior Paediatric Dietitian, Mater Health Services, Mater Children’s Hospital. (Nov 2011). The Modified Atkins Diet. Epilepsy Queensland Inc.

…high-fat diet… for difficult to treat seizures. Heavy cream, butter and vegetable oils provide the necessary fat… allows all protein rich foods… meat, chicken, eggs and fish. It completely eliminates sweets… lollies, biscuits and desserts… carbohydrate rich foods… bread, potatoes, rice, pasta and cereals are not allowed in the first month… may be introduced later.

Children and teenagers with uncontrolled seizures may be helped by the diet.

Medications may act stronger with the Modified Atkins Diet therefore close medical monitoring is necessary.

The diet is generally used for a period of 2 years… If the diet is not helpful, it will be stopped within a few months.

Most children do not develop high cholesterol levels while on the diet. If a child develops high cholesterol or lipids, the diet can be modified to lower these.

This diet should not be started without medical and dietetic supervision.

See also:

David C. Spencer. (2017). Navigating Life with Epilepsy. New York. Oxford University Press. [Diet Therapy]

Male Health – Andropause & Hypogonadism

Hope this piece would shed some light, and facilitate research (either for caregivers, friends, or simply lovers of knowledge).

Andropause is often called ‘Male menopause.’ This is technically incorrect. From the below references, Andropause is not instantaneous but extended: it can occur from age 30 onward; the US Mayo Clinic estimates a yearly 1% fall in testosterone. (The UK National Health Service, NHS puts this at 2% a year, and it can begin as as late as 40.)

A related condition is Hypogonadism. Male hypogonadism is the inability of the testes/testicles to generate testosterone (the main male androgen). Dr Andy Altman, urologist at the US Cleveland Clinic stated that Primary hypogonadism could be a result of “trauma or infection, medications” etc. Secondary hypogonadism, on the other hand, is triggered by faulty signals from brain and/or pituitary gland to the testes. [The NHS observes that hypogonadism is more frequent for the obese and those afflicted with Type 2 Diabetes.]

Please note as with any condition, testosterone deficiency can have multiple causes (i.e. multifactorial). In addition, consider the advice of Dr Altman:

“If a man has low to borderline testosterone and no symptoms, then he need not be treated, and he doesn’t have “andropause.”

Males with very low testosterone may present with the following (non-exhaustive) symptoms:

  • Poor concentration
  • Low energy levels or fatigue
  • Attitude changes and mood swings
  • Depression
  • Low sex drive
  • Erectile dysfunction
  • Loss of muscle mass and strength
  • Memory difficulties
  • Insomnia or excessive sleepiness
  • Bone loss and osteoporosis (over the long run)

Various cures are suggested by medical practitioners.  Among others, there are testosterone pills, diet improvements, and exercise. The key is to see whether low testosterone is a problem and to identify the source(s) and solution(s) with guidance from qualified medical professionals. If needed, please seek a second opinion.


  1. [A Singapore based health screening on 1,000 men between 2007 and 2009 indicated that 26.4% suffered from some form of androgen (male hormone) deficiency or a low level of testosterone.] Department of Geriatric Medicine & Department of Urology, Singapore General Hospital. (no date). Andropause or Male Menopause: What Causes It? SingHealth. 
  2. [This source also discuss lifestyle and psychological reasons.] NHS. (8 Apr 2016). The ‘Male Menopause’. NHS Choices. United Kingdom.
  3. Mayo Clinic Staff. (18 May 2017). Male menopause: Myth or reality? Mayo Foundation for Medical Education and Research (MFMER). US.
  4. Cleveland Clinic. (no date). Male Menopause. The Cleveland Clinic Foundation. Cleveland, US.
  5. Andy Altman. (30 Jun 2016). Hypogonadism in the Aging Male. [Transcript of Online Health Chat, Health Library]. Cleveland Clinic. Cleveland, US.

Other medications/remedies – Epilepsy

This post is linked to an earlier medication resource/research on epilepsy (Singaporean source).

Here we focus on 2 medicines – Carbamazepine (earlier generation) and Levetiracetam (newer generation). The intent is to analyse/compare potential side/adverse effects.  Where similar side effects are found, I have listed them in BOLD. The side effects of each drug are displayed through 4 columns with the title of each source at the top rows. The sources differ on the frequency of the side effects as well. Bear in mind that dispensing medication is a complex decision process. At times it takes monotherapy (medical treatment using a single drug/therapy), the other approach is polytherapy (two drugs or more).

There are related resources at the end of this post.

Should you wish to explore further, please consult a qualified medical profession.

Some brands for Carbamazepine (United States):

  • Carbatrol®
  • Epitol®
  • Equetro®
  • Tegretol®
  • Tegretol®-XR
  • Teril® Suspension

Some brands for Levetiracetam (New Zealand and/or United States):

  • Everet®
  • Keppra®
  • Levetiracetam (Rex)®
  • Levetiracetam-AFT®
Health Navigator New Zealand   Medline Plus (US National Library of Medicine)   Understanding Epilepsy (UK)   Navigating Life with Epilepsy (US)
Last reviewed – 20 Dec 2017


  Last Revised – 15 May 2017   Published 2009   Published 2017
Feeling sleepy/drowsy/tired,

Feeling dizzy/faint,

Problems with your eyesight – blurred vision/ seeing double,

Feeling sick (nausea),

Stomach upset,


Low mood, suicidal thoughts — thoughts of harming yourself,

Easy bruising/ looking pale/ getting sick often,

Allergic reactions such as skin rash, hives, itches, swelling of the face, mouth or lips, trouble breathing.









Memory problems,




Dry mouth,

Back pain,


Loss of contact with reality,

Chest pain,

Yellowing of the skin or eyes,

Vision problems,

“mental health may change in unexpected ways and you may become suicidal”,

Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).

Double vision,





Gastro- intestinal disturbances,

Appetite deficiency,

Reduced white blood cell count,

Lowered blood sodium levels,

Hepatic (liver) disturbances,

Depression and psychological impacts,

Decreased libido,

Other cardiac and neurological impacts.

Reduced blood sodium levels (Tegretol),

Reduced white blood cell count (Tegretol),

Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN),

Double vision,


Trouble with balance,




_______________ _______________ ______________ _______________ _______________
Health Navigator New Zealand   Medline Plus (US National Library of Medicine)   Understanding Epilepsy (UK)   Navigating Life with Epilepsy (US)
Last reviewed – 21 Dec 2017


Last Revised – 15 Apr 2016 Published 2009


Published 2017


Feeling sleepy/


Feeling dizzy,


Feeling sick (nausea),

Stomach upset,

Suicidal thoughts/ anxiety/ depression,

Allergic reactions such as skin rash, itches, hives.


Unsteady walking,

Loss of balance or coordination,



Loss of appetite,



Being   constipated,

Excessive sleepiness,

Joint pain,

Neck pain,

Double vision,

Seizures that are worse or different than the seizures you had before,

Fever/sore throat/signs of infection,


Blisters on skin,



Swollen face/tongue, “mental health may change in unexpected ways and you may become suicidal”.





Psychosis (delusions/ hallucinations),







Gastro- intestinal disturbances,

Tremor (shaking/ trembling),

Visual disturbances,



Weight adjustments.






Libido issues,




Main sources:

  1. Levetiracetam.
  2. Carbamazepine.
  3. Carbamazepine.
  4. Levetiracetam.
  5. Matthew Walker & Simon Shorvon. (2009). Understanding Epilepsy. Poole, Dorset. Family Doctor Publications.
  6. David C. Spencer. (2017). Navigating Life with Epilepsy. New York. Oxford University Press.

Other references:

Mayo Clinic. Mayo Foundation for Medical Education and Research. See Medicine information.

Ketogenic Diet. (last reviewed 11 Jan 2014). Cleveland Clinic.


Diabetes – Japanese lens

I must say I am rather biased. Due to prior experience, I find (Dr) Asano Tsuguyoshi’s writing on diabetes quite readable. This pictorial and language mix is found in an earlier example: a Japanese book translated into traditional Chinese on cholesterol (similarly a Taiwanese publisher). The said volume was vetted by a doctor from the National Taiwan University.

Some notes (my translation):

Tip 64 – take small bites; chew your food well before swallowing [related to insulin secretion] – Yes! Slow down! Stress is one of the 9 non-genetic causes of Type 2 diabetes listed on p.21 (This also involves anger and worry, p.29).

Others contributors –

  • infection,
  • surgical operation,
  • aging,
  • alcohol,
  • overeating (one component is excess sugary food; this debate is hardly over…)
  • obesity,
  • inadequate exercise,
  • and pregnancy.

Tip 54 – aerobic exercise, continuously > 20 minutes, is useful (converting glucose to energy, reducing blood sugar levels etc.) Instances include golf, walking, jogging, skipping, cycling. Beware of injuries and other biological considerations though!

Tip 21 – Eat bittergourd (苦瓜) – I have heard positive anecdotal evidence about this and read at least one other Chinese (mainland) source that supports this. This food is rather ‘cooling’ nevertheless. Correspondingly, do seek qualified medical advice when incorporating this food into the diet.

Tip 15 – Garlic (蒜) – improves metabolism, among other things – based on experience it can be very ‘heaty’ (This is the traditional Chinese medicine analysis; I took it raw) – from other sources (one Taiwanese and one Singaporean), garlic aids the liver (though not everyone agrees with its helpful cholesterol management effects) – p.89 proposes a garlic juice: mashed garlic cooked for 15 minutes, strained for the juice, to be consumed after it cools – on a Korean showed in Singapore, a dietary/nutrition trained housewife does some thing alike; she produced mashed cooked garlic for her family as a condiment to meals. Still, use the food with caution, it has potential side effects – study, research and consult!

Tip 26 – Green tea – also ‘cooling’; quite a few teas are. [Again, this is traditional Chinese medicine analysis.] The book suggests that green tea can eliminate the stench of garlic (hmmm… to be verified).

Statistics – around the time of publishing, of the above age 60 Taiwanese population, 1 in 5 (20%) suffer from diabetes. The vast majority are Type 2. (Arguably within human influence to help resolve?)

Main Source:

浅野次义著 ; 李久霖译. (2015). 图解高血糖控制, 有效降血糖的70个方法. Among others, he had trained in Paris, France (postgraduate) and worked at Omori Red Cross Hospital. The book inner jacket described him as opening a research institute in 2000 (focusing on good lifestyle habits) and a clinic in the same year. Both are situated in Tokyo, Japan (cross references through in Japanese Kanji and Google Translate).


Med Note – Diabetes & Fatigue

Years back I read this Chinese physician (non-western training) who pointed to excessive fatigue as a reason for diabetes.

I sought further cross referencing.  糖尿病防治100分 (2013, Beijing: 电子工业出版社) by Li Ruihua (李瑞华) is one such source*. I took it because it originated from the People’s Republic of China which offered potentially a complement to the Anglo-Saxon perspective.

“熬夜” which means staying up all night or staying up very late according to the author does contribute to the outbreak of diabetes. Necessarily this also relates to sleep quality and quantity. It has to be deep sleep. By inference, it should be less than 9 hours since the study on p. 47 states increased risk of about 1.7 times for persons who sleep more than 9 hours. The risk is even higher for those who sleep less than 5 hours. Wake up timings should be between 6 to 8 am. Sleep should preferably begin before 10 pm.

* See related entry <Med Note – Sugar and Diabetes>. The author graduated from a medical college in Mongolia (包头医学院). She went on to focus on cardiac and brain issues but seems to have experience with endocrine matters (hospital entry dated 27 Nov 2006).

Related research/articles:

“…for those with low incomes, working long hours was associated with a 29% increased risk of developing diabetes. After the researchers adjusted for other demographic factors, the risk dropped slightly, to 26%.” Karen Kaplan. (25 Sep 2014). Overworked and underpaid? You may be at greater risk of diabetes. Los Angeles Times.

Lindsay Kolowich. (no date) Why Overworking Is Bad For Your Health (And Who’s to Blame). Hubspot.

Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals. (Volume 3, No. 1, Jan 2015). The Lancet Diabetes & Endocrinology.


Med Note – Sugar and Diabetes

Sugar Strategies

A major thrust of the (Singapore’s) Ministry of Health in mitigating diabetes currently is sugar restriction – on a national scale. [Footnote 3 – Diabetes: The War Continues. (22 Aug 2017). Press Release.]

Sugar-sweetened beverages (SSBs) is a key area of focus in reducing sugar consumption among Singaporeans. This is because 60% of our total sugar intake comes from sugary beverages such as soft drinks, juices, coffees and teas, with the remaining made up by sugar from foods (e.g. cakes, desserts, and confectionaries). Singaporeans, on average, currently consume more than 1,500 teaspoons of sugar from pre-packaged SSBs annually

[It is heartening nevertheless that the same article describes other areas being targeted. (“Besides reducing sugar intake, overall dietary improvement forms an important part in the development of healthy lifestyle habits.“)]

Yet how much blame should sugar take? The Food Detectives vs. Diabetes (televeision programme hosted by Nikki Muller) in Episode 1 showed us a doctor (Dr Goh, “an endocrine specialist” – Saint-Julien Clinic)* who stated: “Sugar doesn’t really cause diabetes per se…” [my transcription; per se means: by or of itself – Cambridge Dictionary]

Likewise, you have the American Diabetes Association explaining via Diabetes Myths (5 Jul 2017):

Myth: Eating too much sugar causes diabetes.
Fact: The answer is not so simple. Type 1 diabetes is caused by genetics and unknown factors that trigger the onset of the disease; type 2 diabetes is caused by genetics and lifestyle factors. Being overweight does increase your risk for developing type 2 diabetes, and a diet high in calories from any source contributes to weight gain. Research has shown that drinking sugary drinks is linked to type 2 diabetes.

Then Chinese source, 糖尿病防治100分 (2013, Beijing: 电子工业出版社) by Li Ruihua (李瑞华) wrote on p.9 that diabetes is not caused by eating excessive sugar. [my translation]

Rather contradictory to the three sources above is the piece from Erin Digitale for Stanford University’s School of Medicine entitled Quantity of sugar in food supply linked to diabetes rates, researcher says (27 Feb 2013). Marion Nestle, New York University professor of nutrition, food studies and public health (see her World Health Organisation bio) was quoted therein:

How much circumstantial evidence do you need before you take action? At this point we have enough circumstantial evidence to advise people to keep their sugar a lot lower than it normally is.”

Related issue: Digestion

Difficult to digest low glycemic index (GI) complex carbohydrates may over the long term cause stomach/gastrointestinal ailments or challenges (in spite of their sugar managing benefits). On a similar note, the Canadian Society of Intestinal Research and Gastrointestinal Society of Canada refers to a condition called Complex Carbohydrate Intolerance (CCI). [Intestinal Gas from Complex Carbohydrates or Lactose Intolerance. (published January/February 2001. Inside Tract® newsletter issue 123). Accessed 12 Dec 2017.] Thus, we need to look at each person’s situation holistically.


*Video link on Toggle. [It was uploaded in Oct 2017.]

(2016). 好人养好胃. Nanjing. 江苏凤凰科学技术出版社. Tang Xudong (唐旭東, Editor). See an introduction on this gastrointestinal doctor from The Chinese University of Hong Kong from 2016. (It seems in sync with the brief provided by the book jacket.)

“…table sugar, a simple carb, is digested more quickly than steel-cut oats, but more slowly than whole wheat bread… low glycemic complex carbs, but digestion will occur over a longer period of time compared to high glycemic complex carbs.” Aglaée Jacob. How Long Do Complex Carbs Take to Digest? [The author was trained in Nutrition from Laval University in Québec City, Canada.]