Cognitive Retraining for Low Resource and Literacy Settings—Protocol Needed

Epilepsy affects cognition and adversely impacts the psychosocial well-being and quality of life. Significant literature is available for cognitive retraining (CR) for the literate and resourceful.[1] 80% of epileptics live in resource-limited and poorly literate countries,[2] and need an appropriate CR protocol. CR should be directed to the individual deficits, for instance, memory, attention, and execution. For resource-limited settings, the manualized methods, though less precise, are cost-effective. Weekly training sessions can be done;[3,4] however, they are difficult due to financial costs incurred during travel and stay. Home-based CR[5] is a low-cost solution but needs a literate caregiver. Even one family member, if literate and devoted, can provide home-based CR. Joint families provide good opportunity, and help of neighbors can also be taken. Community-based CR with a dedicated literate, such as multipurpose health worker, can train several patients. Special schools and innovative ways such as pamphlets and notebooks are other good ways.[6] There is a need to strengthen all facilities especially community-based and involvement of existing ones such as primary and secondary health centers. Mobile phones are used even in underdeveloped countries, and many free-of-cost brain-training apps can be utilized. Low-cost CR models for traumatic brain injury patients have been successful,[7] and can be tried for epilepsy patients. For illiterate patients, innovative methods for attention, short-term memory, verbal and visual memory can be devised. These tasks can come from daily chores. Relaxation and breathing retraining exercises are possible in any setting. Yoga augments cognitive learning, working memory maintenance, working memory manipulation, and attentive mindfulness.[8,9] Motivation is vital for CR, and both the patient and relatives should be encouraged to regain cognitive functions. Progress and compliance monitoring is significant and can be done by telemedicine. It can be through mobile phones or dedicated peripheral health centers. Presently, there is a lack of a standard protocol of CR for resource-limited and illiterate societies, and there is both demand and opportunity to design it. Recently, “Prehabilitation,” that is, optimizing cognition in anticipation of losses after epilepsy surgery, has come.[10] It might increase the brain’s plasticity and shift functions away from the area to be resected.[11] The prehabilitation will also require a protocol for the said population. Finally, the protocol should be standardized and scrutinized through rigorous clinical trials.