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Further Study Needed on Cognitive Effects of New Antiepileptic Drugs
A DGReview of :"Newer antiepileptic drugs and cognitive issues"
Epilepsia
07/09/2003
By Deanna M. Green
More studies are needed on the effects of newer antiepileptic drugs on cognitive function, according to a recent review from The Netherlands.
Memory impairment, mental slowing, and attention deficits are common secondary effects experienced by patients with epilepsy. In some patients, cognitive impairment can be more debilitating than the associated seizures.
Some antiepileptic drugs are effective in treating epileptic seizure activity, yet exacerbate cognitive dysfunction. Newer drugs are needed with similar efficacy in the treatment of both seizure activity and cognitive function.
Dr. Albert P. Aldenkamp at the Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands, and colleagues in Heeze and Amsterdam, reviewed the effects of antiepileptic drugs on cognitive function. The review consisted of data from randomised clinical trials wherein AED monotherapy was used to treat patients with newly diagnosed epilepsy.
Studies have well-documented that all the common AEDs (i.e., valproate, carbamazepine, phenytoin, phenobarbital) have mild to moderate effects on cognitive functions. Furthermore, adverse cognitive effects appear to be worse with combinatorial treatment.
Newer AEDs appear to have similar efficacy and safety profiles to common AEDs; however meta-analyses of effects on cognitive function are needed.
Some evidence is available for lamotrigine, topiramate, and oxcarbazepine, yet insufficient evidence has been presented for 3 newer AEDs, tiagabine, gabapentin, and levetiracetam.
From available studies, it has been concluded that oxcarbazepine and lamotrigine do not affect cognitive function in healthy volunteers or in adults with newly diagnosed epilepsy. Though, more studies are needed with regard to oxcarbazepine treatment in children. Lamotrigine has also been suggested to help improve memory, particularly in elderly patients with age-associated memory impairment.
In contrast, topiramate has been found to affect cognitive function. Specifically, treatment has adverse effects on attention and verbal function and language.
Due to the lack of controlled studies of the newer AEDs, Dr. Aldenkamp advocates that "much more attention is warranted in drug development and in postmarketing evaluation to establish the effect of drugs on behaviour."
Epilepsia 2003;44:4:21-29.
"Newer antiepileptic drugs and cognitive issues"
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