Epilepsy, AED, and cognition

Abstract

Cognitive impairment in epilepsy results from the complex interaction of more static and sometimes progressive morphological lesions with the more dynamic effects of seizures and antiepileptic drug (AED) treatment. Cognitive treatment-related side effects determine the long-term retention of AED, and in chronic epilepsy, side effects of AED may impair the patients' quality of life more than seizure frequency. A great variety of paper pencil tests, computerized tests, questionnaires, or rating scales is available for assessing cognitive side effects of AED. However, subjective complaints, ratings or quality of life measures often lack validity and appear to reflect the patient's mood more than his factual impairments. Routine monitoring of individual patients with objective tests would be appreciated but requires valid, easy applied, brief, and repeatable measures to become accepted. In this regard, it will be discussed, whether a short screening tool of executive functions, which was explicitly designed to assess AED effects in epilepsy patients and which has successfully applied in recent drug trials, is suited to model the known cognitive effects of common old and new AED when used in mono- or polytherapy. In addition, the question of the usefulness of memory testing or application of computerized tests including simple and choice reaction times for the assessment of cognitive AED effects will be addressed. In summary, the clinical relevance of cognitive AED effects and the necessity of approaching the individual patients when treating epilepsy are emphasized.