Neurocognitive Effects of Antiseizure Medications in Children and Adolescents with Epilepsy

Besag, Frank; Vasey, Michael J.

doi:10.1007/s40272-021-00448-0

Cited by 54 publications

(48 citation statements)

References 204 publications

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“…In more than a fifth of patients a discontinuation of ASM was possible. ASM, particularly polypharmacy, has a significant impact on cognitive development [47,48]. The complete withdrawal or reduction of ASM after surgery are both predictors for better cognitive development after epilepsy surgery [49].…”

Section: Discussionmentioning

confidence: 99%

Epilepsy surgery in the first six months of life: A systematic review and meta-analysis

Makridis

Atalay

Thomale

et al. 2022

Seizure

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Section: Discussionmentioning

confidence: 99%

Epilepsy surgery in the first six months of life: A systematic review and meta-analysis

Makridis

Atalay

Thomale

et al. 2022

Seizure

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“…Levetiracetam does not appear to have a significant detrimental effect on cognition, and it may even have some benefits on certain aspects [ 130 – 132 ]. For example, in one RCT in children and adolescents with DRE and an IQ ≥ 65, no differences were found between LEV and placebo in memory and attention [ 133 ], while in the long-term open-label extension study, cognitive functioning (Leiter-R Score) was stable and behavioural and emotional functioning (CBCL) showed slight improvements from baseline to week 48 [ 134 ].…”

Section: Asms Used In the Treatment Of More Than One Of The Syndromes...mentioning

confidence: 99%

Psychobehavioural and Cognitive Adverse Events of Anti-Seizure Medications for the Treatment of Developmental and Epileptic Encephalopathies

Strzelczyk

Schubert‐Bast

2022

CNS Drugs

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The developmental and epileptic encephalopathies encompass a group of rare syndromes characterised by severe drug-resistant epilepsy with onset in childhood and significant neurodevelopmental comorbidities. The latter include intellectual disability, developmental delay, behavioural problems including attention-deficit hyperactivity disorder and autism spectrum disorder, psychiatric problems including anxiety and depression, speech impairment and sleep problems. Classical examples of developmental and epileptic encephalopathies include Dravet syndrome, Lennox–Gastaut syndrome and tuberous sclerosis complex. The mainstay of treatment is with multiple anti-seizure medications (ASMs); however, the ASMs themselves can be associated with psychobehavioural adverse events, and effects (negative or positive) on cognition and sleep. We have performed a targeted literature review of ASMs commonly used in the treatment of developmental and epileptic encephalopathies to discuss the latest evidence on their effects on behaviour, mood, cognition, sedation and sleep. The ASMs include valproate (VPA), clobazam, topiramate (TPM), cannabidiol (CBD), fenfluramine (FFA), levetiracetam (LEV), brivaracetam (BRV), zonisamide (ZNS), perampanel (PER), ethosuximide, stiripentol, lamotrigine (LTG), rufinamide, vigabatrin, lacosamide (LCM) and everolimus. Bromide, felbamate and other sodium channel ASMs are discussed briefly. Overall, the current evidence suggest that LEV, PER and to a lesser extent BRV are associated with psychobehavioural adverse events including aggressiveness and irritability; TPM and to a lesser extent ZNS are associated with language impairment and cognitive dulling/memory problems. Patients with a history of behavioural and psychiatric comorbidities may be more at risk of developing psychobehavioural adverse events. Topiramate and ZNS may be associated with negative effects in some aspects of cognition; CBD, FFA, LEV, BRV and LTG may have some positive effects, while the remaining ASMs do not appear to have a detrimental effect. All the ASMs are associated with sedation to a certain extent, which is pronounced during uptitration. Cannabidiol, PER and pregabalin may be associated with improvements in sleep, LTG is associated with insomnia, while VPA, TPM, LEV, ZNS and LCM do not appear to have detrimental effects. There was variability in the extent of evidence for each ASM: for many first-generation and some second-generation ASMs, there is scant documented evidence; however, their extensive use suggests favourable tolerability and safety (e.g. VPA); second-generation and some third-generation ASMs tend to have the most robust evidence documented over several years of use (TPM, LEV, PER, ZNS, BRV), while evidence is still being generated for newer ASMs such as CBD and FFA. Finally, we discuss how a variety of factors can affect mood, behaviour and cognition, and untangling the associations between the effects of the underlying syndrome and those of the ASMs can be challenging. In particular, there is enormous h...

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“…5 Remarkably few studies provide robust data on the cognitive effects of ASMs in the pediatric population. 6 Thus, it is important to assess both the efficacy and tolerability of ASMs for the treatment of LGS, especially in younger patients.…”

Section: Backgrou N Dmentioning

confidence: 99%

“…Since drug resistance is common, affected individuals may be exposed to a greater number and diversity of ASMs over the long term 5 . Remarkably few studies provide robust data on the cognitive effects of ASMs in the pediatric population 6 . Thus, it is important to assess both the efficacy and tolerability of ASMs for the treatment of LGS, especially in younger patients.…”

Section: Introductionmentioning

confidence: 99%

Are anti‐seizure medications effective and safe treatments for Lennox–Gastaut syndrome? A Cochrane Review summary with commentary

Kolaski

2022

Develop Med Child Neuro

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The aim of this commentary is to discuss from a rehabilitation perspective the Cochrane Review 'Anti-seizure medications for Lennox-Gastaut syndrome' 1 by Brigo et al.,* published by the Cochrane Epilepsy Group. This Cochrane Corner is produced in agreement with Developmental Medicine & Child Neurology by Cochrane Rehabilitation with views of the review summary author in the 'implications for practice' section.

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Neurocognitive Effects of Antiseizure Medications in Children and Adolescents with Epilepsy

Cited by 54 publications

References 204 publications

Epilepsy surgery in the first six months of life: A systematic review and meta-analysis

Epilepsy surgery in the first six months of life: A systematic review and meta-analysis

Psychobehavioural and Cognitive Adverse Events of Anti-Seizure Medications for the Treatment of Developmental and Epileptic Encephalopathies

Are anti‐seizure medications effective and safe treatments for Lennox–Gastaut syndrome? A Cochrane Review summary with commentary

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