Effect of lamotrigine on cognition in children with epilepsy

Pressler, Ronit; Binnie, C. D.; Coleshill, Steven G.; Chorley, G.; Robinson, Richard O.

doi:10.1212/01.wnl.0000216273.94142.84

Cited by 63 publications

(39 citation statements)

References 31 publications

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“…One double-blind, placebo-controlled crossover study of 81 patients with refractory partial seizures demonstrated no adverse effect on cognition in association with lamotrigine [Smith et al 1993], and other studies have reported similar findings [Bootsma et al 2008b;Gillham et al 2000;Aldenkamp et al 1997]. For example, in a double-blind, placebocontrolled study involving children, there were no differences in the results of cognitive tasks assessing reaction time, recognition memory, attention, visual search and working memory [Pressler et al 2006]. Positive effects on cognitive function in epilepsy have also been reported [Placidi et al 2000;Banks and Beran, 1991].…”

Section: Pregabalinmentioning

confidence: 79%

The cognitive impact of antiepileptic drugs

Eddy¹,

Rickards²,

Cavanna³

2011

Ther Adv Neurol Disord

324

189

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Effective treatment of epilepsy depends on medication compliance across a lifetime, and studies indicate that drug tolerability is a significant limiting factor in medication maintenance. Available antiepileptic drugs (AEDs) have the potential to exert detrimental effects on cognitive function and therefore compromise patient wellbeing. On the other hand, some agents may serve to enhance cognitive function. In this review paper, we highlight the range of effects on cognition linked to a variety of newer and older AEDs, encompassing key alterations in both specific executive abilities and broader neuropsychological functions. Importantly, the data reviewed suggest that the effects exerted by an AED could vary depending on both patient characteristics and drug-related variables. However, there are considerable difficulties in evaluating the available evidence. Many studies have failed to investigate the influence of patient and treatment variables on cognitive functioning. Other difficulties include variation across studies in relation to design, treatment group and assessment tools, poor reporting of methodology and poor specification of the cognitive abilities assessed. Focused and rigorous experimental designs including a range of cognitive measures assessing more precisely defined abilities are needed to fill the gaps in our knowledge and follow up reported patterns in the literature. Longitudinal studies are needed to improve our understanding of the influence of factors such as age, tolerance and the stability of cognitive effects. Future trials comparing the effects of commonly prescribed agents across patient subgroups will offer critical insight into the role of patient characteristics in determining the cognitive impact of particular AEDs.

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Section: Pregabalinmentioning

confidence: 79%

The cognitive impact of antiepileptic drugs

Eddy¹,

Rickards²,

Cavanna³

2011

Ther Adv Neurol Disord

324

189

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“…The study, while showing improvement in declarative memory, does not prove that the memory improvement was related to an interaction with the corticosteroids. In patients with seizures, lamotrigine appears to have a more benign effect on cognition than some other antiseizure medications (Pressler et al, 2006). In healthy controls (Aldenkamp et al, 2002) and in animal models (Shannon and Love, 2004) lamotrigine appears to be associated with no significant changes in cognitive performance.…”

Section: Discussionmentioning

confidence: 97%

Attenuation of the Effects of Corticosteroids on Declarative Memory with Lamotrigine

Brown

Wolfshohl

Shad

et al. 2007

Neuropsychopharmacol

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An extensive animal literature suggests that excessive corticosteroid exposure is associated with changes in memory and the hippocampus. Agents that decrease glutamate attenuate corticosteroid effects on the hippocampus. Minimal data are available on preventing or reversing corticosteroid effects on the human hippocampus. We previously reported that open-label lamotrigine was associated with significant improvement in declarative memory in corticosteroid-treated patients. We now examine the impact of 24 weeks of randomized, placebo-controlled lamotrigine therapy on declarative memory (primary aim) and hippocampal volume (secondary aim) in 28 patients (n ¼ 16 for lamotrigine, n ¼ 12 for placebo) taking prescription corticosteroids. All participants with data from at least one postbaseline assessment (n ¼ 9 for lamotrigine, n ¼ 11 for placebo) were included in the analysis. Declarative memory was assessed with the Rey Auditory Verbal Learning Test (RAVLT) at baseline and weeks 12 and 24. Hippocampal and total brain volumes were manually traced from MRI scans obtained at baseline and week 24. On the basis of an ANCOVA analysis, total words learned on the RAVLT at exit were significantly greater in the lamotrigine group (n ¼ 8, missing data or dropouts n ¼ 8) compared to the placebo group (n ¼ 11, dropout n ¼ 1). RAVLT scores in the lamotrigine group increased from mildly impaired to average range. Hippocampal volume changes were small in both lamotrigine (n ¼ 7) and placebo (n ¼ 7) groups during the 24-week assessment period and between-group differences were not significant. Results suggest that lamotrigine may improve declarative memory in patients taking prescription corticosteroids although differential dropout rate in the two groups is a concern.

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“…In children, no significant differences were present for lamotrigine compared to placebo on a computerized battery of cognitive tests (Pressler et al 2006). In the recent VA Cooperative study of elderly patients with new onset epilepsy, lamotrigine was the best tolerated, followed by gabapentin and then carbamazepine, although no formal neuropsychological data was reported (Rowan et al 2005).…”

Section: Lamotrigine (Lamictal)mentioning

confidence: 96%

Neuropsychological and Behavioral Effects of Antiepilepsy Drugs

2007

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Antiepilepsy drugs work by decreasing neuronal irritability, which may also result in the non-desired side effect of decreased neuropsychological function. In addition to cognitive side effects, antiepilepsy drugs (AEDs) may be associated with behavioral effects which may range from irritability and hyperactivity to positive psychotropic effects on mood. There have been many new medications released since the 1990s, and although they tend to have more favorable side effect profiles compared to their older counterparts, there continues to be a risk of decreased cognitive function with the majority of these agents. The effects of in utero antiepilepsy drug exposure are increasingly being investigated, and differential drug risk is beginning to be described for both anatomic and cognitive outcomes. Patients with epilepsy undergoing neuropsychological evaluations are commonly on AEDs, and it is important for the clinician to recognize the potential contribution of AED therapy to neuropsychological profiles. The present article serves to provide an overview of our current understanding regarding the risks of antiepilepsy drug use for both cognitive and behavioral side effects.

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Effect of lamotrigine on cognition in children with epilepsy

Abstract: Lamotrigine exhibits no clinically significant cognitive effects in adjunctive therapy for children with epilepsy.

Cited by 63 publications

References 31 publications

The cognitive impact of antiepileptic drugs

The cognitive impact of antiepileptic drugs

Attenuation of the Effects of Corticosteroids on Declarative Memory with Lamotrigine

Neuropsychological and Behavioral Effects of Antiepilepsy Drugs

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