Effect of anti-epileptic drugs on cognitive functions: a prospective study in individuals with newly diagnosed complex partial seizure and generalized tonic clonic seizure

Abstract

INTRODUCTIONEpilepsy is a chronic condition of recurrent seizures that can also vary from brief and nearly undetectable symptoms to periods of vigorous shaking and convulsions.1 Seizures are episodic high-frequency discharge of impulses by a group of neurons in a particular area in the brain. 2 The electrical balance underlying normal neuronal activity is pathologically altered during seizures-excitation predominates over inhibition. The therapeutic goal of anti-epileptic drugs is to maximize seizure control while minimizing adverse drug effects, thus improving the patient's quality of life. Cognitive dysfunction is seen in a sizeable number of patients with epilepsy. Anti-epileptic drugs are able to improve cognition and behaviour by reducing seizure activity and modifying effects of neurotransmitter.Several relationships exist between cognitive impairment and epilepsy-related or treatment-related factors. The central cognitive side effect of the anti-epileptic drugs is one of the most important treatment-related factors. Present study was carried out in the Department of Medicine, Government Medical College, Surat with an ABSTRACT Background: Epilepsy, the third most common neurologic disorder, deteriorates cognitive functions of the patients. Approximately 1% of the world's population is suffering from epilepsy. Opinions regarding impact of anti-epileptic drugs on cognition are divided. So, this study was designed to assess the impact of anti-epileptic drugs on cognitive performance of patients with complex partial seizure and generalized tonic clonic seizure in Department of Medicine, at Government Medical College, Surat, Gujarat, India. Methods: In present study, cognitive functions were assessed in 50 patients of newly diagnosed complex partial seizure and generalized tonic clonic seizure coming to the Department of Medicine, Surat. The cognitive functions were evaluated by Addenbrooke's Cognitive Examination (ACE)-III, which assessed memory, attention, fluency, language and visuo-spatial abilities. Follow-up was done after six months of baseline. Results: Baseline and Follow-up data from 50 patients were analysed. Patient treated with anti-epileptic drugs showed significant improvement in memory, attention, language and visuo-spatial abilities whereas improvement in fluency was not significant. Paired t-test and Wilcoxon Signed Ranks Test were used to analyse the data. For statistical analysis of data SPSS 19.0 software was used. Conclusions:The available data indicate that the anti-epileptic drugs on shortterm administration do not adversely affect cognitive function in patients with newly diagnosed CPS and GTCS. Importantly, the data suggest that the effects exerted by AEDs could depend on factors linked to patient characteristics and individual susceptibility and to comment on those factors further studies are needed.