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Chapter 15 - Antiepileptic drugs and cognitive disorders

Published online by Cambridge University Press:  07 October 2011

By
Albert P. Aldenkamp
Edited by
Michael R. Trimble  and
Bettina Schmitz
Michael R. Trimble
Affiliation:
Institute of Neurology, London
Bettina Schmitz
Affiliation:
Vivantes, Humdoldt-Klinikum, Berlin, Germany
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Summary

Cognitive impairment is the most common comorbid disorder in epilepsy. Several new antiepileptic drugs (AEDs) have been introduced. Several studies have shown retention rate to be the best parameter of the long-term clinical usefulness of a particular drug. Cognitive side effects have been demonstrated to be one of the most important tolerability problems in chronic AED treatment. Randomized clinical trials with monotherapy in patients with newly diagnosed epilepsy represent the most accurate procedure for assessing the cognitive impact of AEDs. Definite evidence for drug-induced cognitive impairment has been established for phenobarbitone (memory impairment), phenytoin (mental slowing), and topiramate (mental slowing and dysphasia). Treatment with these drugs should consider these side effects, and patients should be monitored on a regular basis. Mild effects (mostly psychomotor slowing) were found for carbamazepine, oxcarbazepine, valproate, and lamotrigine (with mild cognitive activating effects). The effects for ethosuximide, tiagabine, gabapentin, levetiracetam, and zonisamide are inconclusive.

Keywords

depressionepilepsyfrontal lobe dysfunctionlabile depressive symptomslabile affective symptomsinterictal dysphoric disorderinterictal dysphoric disorder inventory
Type
Chapter
Information
The Neuropsychiatry of Epilepsy , pp. 153 - 164
Publisher: Cambridge University Press
Print publication year: 2011

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