Cross-sensitivity of patient-perceived adverse cognitive effects with antiepileptic drug use

Chen, Baibing; Detyniecki, Kamil; Hirsch, Lawrence J.; Moeller, Jeremy J.; Javed, Asif; Kato, Kenneth; Legge, Alexander; Buchsbaum, Richard; Choi, Hyunmi

doi:10.1016/j.yebeh.2015.03.020

Cited by 3 publications

(3 citation statements)

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“…However, adverse cognitive effects from AEDs worsen as the total drug load increases [59], and this applies also to ZNS [54]. One study that examined the frequency of intolerable adverse cognitive effects (IACEs) in patients with a total drug load of at least two AEDs showed that ZNS had the next highest IACE rate (10%) after topiramate (26%) [60]. Both ZNS and topiramate have in common a sulfa moiety which is suspected to increase GABA activity especially in the prefrontal cortex.…”

Section: Safety and Tolerabilitymentioning

confidence: 99%

An evaluation of zonisamide, including its long-term efficacy, for the treatment of focal epilepsy

Reimers

Ljung

2019

Expert Opinion on Pharmacotherapy

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Introduction: About 70 million people worldwide are estimated to suffer from epilepsy. Despite a large variety of old and new antiepileptic drugs on the market, about 30% of people with epilepsy do not become seizure-free with medical treatment. This is a major individual and public health burden. Most of these difficult-to-treat patients are having focal seizures. Zonisamide is effective against focal seizures in adults and children and, thus, a therapeutic option for such patients. Its safety profile needs special attention. Areas covered: Herein, the authors discuss the pharmacology, clinical efficacy and the adverse effects of zonisamide. The article is derived from clinical trial data, long-term studies, meta-analyses, review articles, text books, webpages, and official license information. Expert opinion: Zonisamide has proven to be efficacious in focal epilepsy in children and adults, although it is not more effective than carbamazepine or other antiepileptic drugs. It is also effective in generalized epilepsy and in several other conditions of the CNS. Its safety profile may prevent it from becoming a first-line drug for focal epilepsy or any other indication.

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Section: Safety and Tolerabilitymentioning

confidence: 99%

An evaluation of zonisamide, including its long-term efficacy, for the treatment of focal epilepsy

Reimers

Ljung

2019

Expert Opinion on Pharmacotherapy

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“…PBSEs are difficult to predict in patients taking AEDs, but there are some evidence that age, sex, psychiatric history, and genetic variations may be risk factors for developing psychiatric side effects [3,13,14]. Cross-sensitivity among specific AEDs has been reported with adverse effects such as skin rash and with adverse cognitive effects [15][16][17][18][19][20][21]. However, potential cross-sensitivities of PBSEs amongst AEDs are not known in the literature and can be difficult to predict.…”

Section: Introductionmentioning

confidence: 99%

Cross-sensitivity of psychiatric and behavioral side effects with antiepileptic drug use

Chen

Choi

Hirsch

et al. 2018

Seizure

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To determine rates of cross-sensitivity of intolerable psychiatric and behavioral side effects (IPBSEs) among commonly used antiepileptic drugs (AEDs) in adult patients with epilepsy. Methods: IPBSE was defined as a psychiatric or behavioral side effect attributed to AED use that led to a decrease in dose or cessation of an AED. Cross-sensitivity was calculated and was defined as the likelihood of developing IPBSE to a specific AED given IPBSE to another AED. Our sample consisted of 2312 adult patients that were prescribed 2 or more AEDs. Non-AED confounders and were controlled for in all analyses. Results: Among the 2312 patients, 20.2% of patients who had taken at least 2 AEDs had IPBSE(s) attributed to at least one AED; 3.5% had IPBSE to two or more AEDs. History of treated depression and psychosis were found to be significant predictors (p < 0.001) of developing IPBSE and were controlled for in all AED-specific analyses. Cross-sensitivity was seen between LEV and ZNS (p < 0.001). There was a significant increase in odds of experiencing IPBSE to LEV (41.5%; OR = 2.7; p < 0.001) or ZNS (22.1%; OR = 3.5; p < 0.001) given a patient had IPBSE to another AED compared to having no IPBSE to other AEDs (20.5% and 7.5%, respectively). Conclusion: History of depression and psychosis increased risk of developing IPBSE to AEDs. The probability of experiencing IPBSE increased for a patient taking LEV or ZNS if the patient experienced IPBSE to another AED. Our results may be clinically useful for predicting IPBSE associated with certain AEDs.

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“…The meta-analysis by Chadwick and Marson [ 8 ] reported that the most frequent adverse effects of ZNS treatment were ataxia, dizziness, somnolence, nervousness, and anorexia, indicating a predominance of cognitive adverse effects. However, a recent study found no differences between ZNS- and VPA-treated patients in the subjective perception of cognitive or neuropsychiatric adverse effects [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Cognitive Profile of Zonisamide and Valproic Acid in the Treatment of Idiopathic Generalized Epilepsy: A Comparative Observational Study

et al. 2016

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IntroductionCalls for an alternative to valproic acid (VPA) as drug of choice for idiopathic generalized epilepsies (IGEs) have intensified since the recent International League Against Epilepsy recommendation that the drug should not be administered to women of childbearing age. Zonisamide (ZNS), a third-generation antiepileptic drug, has proven effective in generalized seizures and could be considered an alternative to VPA in this population.ObjectivesThe present study was designed to examine possible differences in cognitive profile between ZNS and VPA as monotherapy in patients with IGE in real-life settings.MethodsWe conducted a comparative, descriptive, observational, retrospective cohort study in two groups of patients diagnosed with IGE treated with ZNS ≥200 mg/day or VPA ≥1000 mg/day as stable monotherapy for at least the previous 6 months. We used specific neuropsychological tests for short- and long-term mnemonic functions, working memory, visuospatial speed, attention and processing speed, verbal fluency, executive functions, visual perception, abstraction, anxiety, depression, and apathy.ResultsWe included 16 patients in the study: eight in the VPA and eight in the ZNS group. Significantly superior mean scores were obtained by the VPA group in working memory (Forward Digits test) and by the ZNS group in execution time for the Rey–Osterrieth complex figure test. No statistically significant differences were found between the groups in the remaining tests.ConclusionZonisamide as monotherapy has a similar cognitive profile to that of VPA in patients with IGE. The final treatment selection setting should be individualized. ZNS may be a reasonable alternative to VPA in some cases in this population.

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Cross-sensitivity of patient-perceived adverse cognitive effects with antiepileptic drug use

Cited by 3 publications

References 26 publications

An evaluation of zonisamide, including its long-term efficacy, for the treatment of focal epilepsy

An evaluation of zonisamide, including its long-term efficacy, for the treatment of focal epilepsy

Cross-sensitivity of psychiatric and behavioral side effects with antiepileptic drug use

Cognitive Profile of Zonisamide and Valproic Acid in the Treatment of Idiopathic Generalized Epilepsy: A Comparative Observational Study

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