Antiepileptic Drug‐Related Cognitive Complaints in Seizure‐Free Children with Epilepsy Before and After Drug Discontinuation

Abstract

Summary:The cognitive complaints reported by children and their parents, as subjectively associated with antiepileptic drug (AED) treatment, were evaluated in seizure-free children before and after drug discontinuation. The aim of the design was to isolate the cognitive side effects of AEDs from other factors, such as the effect of seizures. Our inventory explored the following areas: "alertness," "concentration," "activation/ tiredness," "memory," "drowsiness," "depression," "aggressiveness," and "hyperactivity," using a 5-point Likert scaling procedure. One hundred two eligible patients were selected, each matched with a healthy control and assessed when still on antiepileptic medication. All children were seizure free for at least 1 year. The medication was then discontinued gradually over a 3-month period. Four months after the children were completely medication free, a second assessment was carried out, but only in the 83 children who remained seizure free and in their matched controls.The results of the reports made by the children themselves did not show differences with the matched controls, and only showed improvement after drug discontinuation for complaints about "tiredness." Parents of the children with epilepsy reported significant improvement in all areas related to "alertness and activation" after discontinuation of the drugs.The finding that only a limited number of children have cognitive complaints, both when still on AEDs and after discontinuation, may be in line with the reports that the major factor contributing to quality of life is whether patients are seizure free or still have seizures. All patients in this study were seizure free for a period >1 year, which may have caused the favorable pattern of response in our patient group.

Speech, language, and cognition in preschool children with epilepsy

“…26 In our study, VIQ was within normal range, although expressive language was affected. The significantly lower PIQ than VIQ in our children with epilepsy is in accordance with the results of Aldenkamp et al 27,28 The differences in arithmetic scores may reflect visuospatial difficulties Bulteau et al found that children treated with more than one AED had a lower IQ. 29 In our children, we could not find such an association, but some speech, language, and neuropsychological functions were affected.…”

Language Disturbances as Side Effects of Topiramate and Zonisamide Therapy

“…Of these 12 patients with deficits related to language, 3 also complained of decreased ability to concentrate, and 1, of transient paresthesias. The remaining 10 patients with adverse effects other than language experienced increased seizure severity or frequency (4), insomnia (3), depression (1), worsening of depression (2), worsening of behavior problem (1), transient paresthesias (1), and weight loss (2). Two patients experiencing toxicity reported better seizure control.…”

“…Studies of the cognitive side effects of antiepileptic drugs (AEDs) have most commonly demonstrated effects in the areas of psychomotor speed, visual-spatial performance, concentration, and memory (1)(2)(3)(4)(5)(6). Missing from this list is language, which has typically not been associated with AED effects.…”

Language Dysfunction Is Associated with Age of Onset of Benign Epilepsy with Centrotemporal Spikes in Children

“…The mechanisms underlying antiepileptic drug-induced cognitive dysfunction in BECTS remain unclear. It has been reported that antiepileptic drugs cause transient cognitive dysfunction in BECTS children, and BECTS children have normal cognitive function one year after antiepileptic drugs are discontinued due to control of epileptic symptoms [11]. Furthermore, several studies have shown that BECTS children with higher intelligence levels are more likely associated with shorter duration of seizure, and greater reading and writing capabilities, and have parents with higher education levels [3,10,12,13,14,15].…”