Research Article| Volume 138, 109000, January 2023

Download started.


Difficulties with mathematics experienced by adults with epilepsy in daily life: An online study

Published:November 26, 2022DOI:


      • Adults with epilepsy reported difficulties in both basic and secondary math skills.
      • Difficulties in working memory accounted for a significant amount of variance in math outcomes.
      • The limited capacity storage component of working memory was detrimental for poor math.
      • Difficulties with mathematics may be comorbid with epilepsy, rather than epilepsy related.



      Mathematics encompass a variety of skills, broadly grouped into basic numeracy to complex secondary mathematical skills. In children with epilepsy difficulties with mathematics are common and related to a multicomponent working memory capacity. Little is known about mathematical skills of adults with epilepsy in daily life. Hence, we aimed to compare basic and secondary mathematical skills of adults with epilepsy to controls, examine relations between mathematical skills and working memory, and explored relationships between mathematical skills and epilepsy variables (age of onset, seizure frequency, and anti-seizure medication).


      Eighty four people with epilepsy and 86 healthy controls completed questionnaires on their subjective experience of using mathematics and working memory skills in daily life: The Dyscalculia Checklist (DC) and Working Memory Questionnaire (WMQ; including attention, storage, and executive scales), respectively. Questionnaires also collected demographic and epilepsy variables.


      Adults with epilepsy reported greater difficulties in basic and secondary mathematical skills on the DC compared with controls. Only one epilepsy variable, a younger age of epilepsy onset, related to higher DC scores (greater mathematical difficulties), but was not significantly related in regression analyses. Instead, the WMQ explained 33% of the variance on the DC; the poorer storage and attention (but not executive) on the WMQ were associated with the higher DC score, when demographic and epilepsy variables were accounted for.


      Adults with epilepsy reported significant difficulties with mathematics in daily life, which were not explained by epilepsy variables but by poor working memory. While our findings suggest that daily difficulties with mathematics may be comorbid with epilepsy rather than epilepsy related, it is important to be cognizant of mathematical difficulties experienced by patients with epilepsy as they have potential to impact understanding of numerical information provided in patient care, such as risks associated with different epilepsy treatments.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Epilepsy & Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Geary D.C.
        From infancy to adulthood: the development of numerical abilities.
        Eur Child Adolesc Psychiatry. 2000; 9: S11-S16
        • Rivera-Batiz F.L.
        Quantitative literacy and the likelihood of employment among young adults in the United States.
        J Hum Resour. 1992; 27: 313
        • Parsons S.
        • Bynner J.
        Numeracy and employment.
        Educ + Train. 1997; 39: 43-51
        • Rathouz P.J.
        • Zhao Q.
        • Jones J.E.
        • Jackson D.C.
        • Hsu D.A.
        • Stafstrom C.E.
        • et al.
        Cognitive development in children with new onset epilepsy.
        Dev Med Child Neurol. 2014; 56: 635-641
        • Jackson D.C.
        • Dabbs K.
        • Walker N.M.
        • Jones J.E.
        • Hsu D.A.
        • Stafstrom C.E.
        • et al.
        The Neuropsychological and Academic Substrate of New/Recent-Onset Epilepsies.
        J Pediatr. 2013; 162: 1047-1053.e1
        • Danguecan A.N.
        • Lou S.M.
        Academic outcomes in individuals with childhood-onset epilepsy: Mediating effects of working memory.
        J Int Neuropsychol Soc. 2017; 23: 594-604
        • Breier J.I.
        • Fletcher J.M.
        • Wheless J.W.
        • Clark A.
        • Cass J.
        • Constantinou J.E.C.C.
        Profiles of cognitive performance associated with reading disability in temporal lobe epilepsy.
        J Clin Exp Neuropsychol. 2000; 22: 804-816
        • Butterbaugh G.
        • Olejniczak P.
        • Roques B.
        • Costa R.
        • Rose M.
        • Fisch B.
        • et al.
        Lateralization of temporal lobe epilepsy and learning disabilities, as defined by disability-related civil rights law.
        Epilepsia. 2004; 45: 963-970
        • Delazer M.
        • Gasperi A.
        • Bartha L.
        • Trinka E.
        • Benke T.
        Number processing in temporal lobe epilepsy.
        J Neurol Neurosurg Psychiatry. 2004; 75: 901-903
        • Arsalidou M.
        • Taylor M.J.
        Is 2+2=4? Meta-analyses of brain areas needed for numbers and calculations.
        Neuroimage. 2011; 54: 2382-2393
        • Dehaene S.
        • Piazza M.
        • Pinel P.
        • Cohen L.
        Three parietal circuits for number processing.
        Cogn Neuropsychol. 2003; 20: 487-506
        • Hermann B.
        • Seidenberg M.
        • Bell B.
        • Rutecki P.
        • Sheth R.
        • Ruggles K.
        • et al.
        The Neurodevelopmental Impact of Childhood-onset Temporal Lobe Epilepsy on Brain Structure and Function.
        Epilepsia. 2002; 43: 1062-1071
        • Raghubar K.P.
        • Barnes M.A.
        • Hecht S.A.
        Working memory and mathematics: A review of developmental, individual difference, and cognitive approaches.
        Learn Individ Differ. 2010; 20: 110-122
        • Baddeley A.
        The fractionation of working memory.
        PNAS. 1996; 93: 13468-13472
        • D’Esposito M.
        From cognitive to neural models of working memory.
        Philos Trans R Soc B Biol Sci. 2007; 362: 761-772
        • Poole B.J.
        • Phillips N.L.
        • Stewart E.
        • Harris I.M.
        • Lah S.
        Working memory in pediatric epilepsy: A systematic review and meta-analysis.
        Neuropsychol Rev. 2021; 31: 569-609
        • Exner C.
        • Boucsein K.
        • Lange C.
        • Winter H.
        • Weniger G.
        • Steinhoff B.J.
        • et al.
        Neuropsychological performance in frontal lobe epilepsy.
        Seizure. 2002; 11: 20-32
        • Chowdhury F.A.
        • Elwes R.D.
        • Koutroumanidis M.
        • Morris R.G.
        • Nashef L.
        • Richardson M.P.
        Impaired cognitive function in idiopathic generalized epilepsy and unaffected family members: an epilepsy endophenotype.
        Epilepsia. 2014; 55: 835-840
        • Vallat-Azouvi C.
        • Pradat-Diehl P.
        • Azouvi P.
        The Working Memory Questionnaire: A scale to assess everyday life problems related to deficits of working memory in brain injured patients.
        Neuropsychol Rehabil. 2012; 22: 634-649
        • Chinn S.
        The dyscalculia checklist. More Troubl. with maths a Complet. Man. to identifying diagnosing Math. difficulties.
        2nd ed.,. Routledge, London2017: 20-34
      1. Australian Bureau of Statistics [ABS]. Household income and wealth, Australia 2020. [accessed July 6, 2022].

        • Cohen J.D.
        Statistican power analysis for the behavioral sciences.
        Elsevier Science and Technology, 2013
        • Choi H.
        • Wong J.B.
        • Mendiratta A.
        • Heiman G.A.
        • Hamberger M.J.
        Numeracy and framing bias in epilepsy.
        Epilepsy Behav. 2011; 20: 29-33
        • Kaur J.
        • Paul B.S.
        • Goel P.
        • Singh G.
        Educational achievement, employment, marriage, and driving in adults with childhood-onset epilepsy.
        Epilepsy Behav. 2019; 97: 149-153
        • Jennum P.
        • Christensen J.
        • Ibsen R.
        • Kjellberg J.
        Long-term socioeconomic consequences and health care costs of childhood and adolescent-onset epilepsy.
        Epilepsia. 2016; 57: 1078-1085
        • Cohen Kadosh R.
        • Dowker A.
        • Heine A.
        • Kaufmann L.
        • Kucian K.
        Interventions for improving numerical abilities: Present and future.
        Trends Neurosci Educ. 2013; 2: 85-93
        • Semenza C.
        • Meneghello F.
        • Arcara G.
        • Burgio F.
        • Gnoato F.
        • Facchini S.
        • et al.
        A new clinical tool for assessing numerical abilities in neurological diseases: Numerical activities of daily living.
        Front Aging Neurosci. 2014; 6