Effects Of Antiepileptic Medications Research Articles

The Effects of Antiepileptic Medications on Lipid Profile, Thyroid Panel, and Vitamin Level.

Background: Conventional antiepileptic drugs (AEDs) have been used for many years to treat epilepsy, and physicians are generally familiar with their side-effect profiles and potential drug interactions. However, AEDs affect patient vitamin and mineral levels in a manner that is not well understood. The goal of this study was to determine the relationship between AEDs and patient vitamins and mineral levels.Materials and methods: We conducted a retrospective analysis of liver enzyme levels, thyroid hormone levels, lipid profiles, and vitamin values (e.g., B12 and folic acid) in patients treated with carbamazepine, valproic acid, or levetiracetam at our institution. Patients were included in the study if their medical data included total cholesterol, triglyceride levels, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels obtained on follow-up at least three months after the start of antiepileptic treatment with carbamazepine, valproic acid, or levetiracetam. Patients were grouped according to the antiepileptic drug used. We analyzed liver thyroid function tests, lipid profiles, levels of B12, and folic acid levels using laboratory test results and compared the findings from each group.Results: Carbamazepine, valproic acid, and levetiracetam did not change the levels of liver enzymes such as aspartate transaminase and alanine aminotransferase (p values respectively: .802, .094). Cholesterol and LDL levels were lower in patients using carbamazepine (p values respectively: .005, .005), and no significant difference was observed for HDL and triglyceride levels (p values respectively: .400, .091). While thyroid-stimulating hormone levels were significantly higher in patients on medication than the control group (p=.007), the levels were still within reference ranges. No significant difference was found between tri-iodothyronine and thyroxine levels (p values respectively: .065, .053). The levels of B12 and folic acid were observed to be high in the group using carbamazepine (p values respectively: .049, .004).Conclusion: Valproic acid and carbamazepine do not induce a significant increase in liver enzymes compared to levetiracetam, a new-generation antiepileptic medication, and they had no impact on lipoproteins such as HDL that are protective against coronary artery disease. These medications do not affect the levels of thyroid hormones in comparison to levetiracetam and the control group. Although carbamazepine and valproic acid are metabolized in the liver, liver enzyme monitoring is required; they have only affected liver enzyme values as much as levetiracetam and the control group.

Letter to the Editor Regarding “The Effectiveness of Antiepileptic Medications as Prophylaxis of Early Seizure in Traumatic Brain Injury Patients Compared to Placebo or No Treatment: A Systematic Review and Meta-Analysis”

Letter to the Editor Regarding “The Effectiveness of Antiepileptic Medications as Prophylaxis of Early Seizure in Traumatic Brain Injury Patients Compared to Placebo or No Treatment: A Systematic Review and Meta-Analysis”

In Reply to the Letter to the Editor Regarding “The Effectiveness of Antiepileptic Medications as Prophylaxis of Early Seizure in Patients with Traumatic Brain Injury Compared with Placebo or No Treatment: A Systematic Review and Meta-Analysis”

In Reply to the Letter to the Editor Regarding “The Effectiveness of Antiepileptic Medications as Prophylaxis of Early Seizure in Patients with Traumatic Brain Injury Compared with Placebo or No Treatment: A Systematic Review and Meta-Analysis”

Prevalence of Depression and its Associated Factors among Adult Epileptic Patients Following Treatment at Selected Public Health Facilities of Bench Maji Zone, South West Ethiopia, 2017

Background: Depression among epileptic patients has multiple effects: poor quality of life, increased seizure frequency, risk of suicide, increased health care cost and worsened side effects of anti-epileptic medications. It is often under recognized and untreated among these patients.Objective: To assess the prevalence of depression and associated factors among epileptic patient on treatment follow up at selected public health facilities of Bench Maji zone, south west Ethiopia, 2017.Methods: Cross-sectional study was conducted in selected public health facilities of Bench Maji zone from March 3- April 3/2017. Simple random sampling was used. Data was collected through face to face interview and analyzed using frequency, percentage and binary logistic.Result: In this study a total of 244 participants were involved, and the response rate was 98.8%. The overall prevalence of depression was 51.2%. Of these, 60%, 36%, and 4% of the patients were found to have mild, moderate and severe depression respectively. Low educational status (AOR=2.5, CI (1.32, 4.78)), Seizure frequencies ≥ 3 per month (AOR=3.06, CI (1.412, 6.65)), Age onset of epilepsy ≤ 11 years (AOR=4.58, CI (1.94, 10.82)), low anti-epileptic drug adherence (AOR=4.81, CI (2.32, 9.97)) and poor knowledge about epilepsy (AOR=2.77, CI (1.5,5.12)) were found to be independent predictors of depression among epileptic patients.Conclusion and recommendation: Considerable amount of epileptic patients had depression that may predispose them to different health related problems. Low educational status, seizure frequencies, age at onset of the epilepsy, low antiepileptic drug adherence and poor knowledge about epilepsy were found to be contributing factor to the depression.

Epileptic encephalopathy: Use and misuse of a clinically and conceptually important concept.

The term epileptic encephalopathy (EE) denotes a process by which epileptic activity adversely affects brain function over and above the underlying etiology. Underlying mechanisms are poorly understood, but recent studies demonstrate that seizures and interictal epileptiform discharges can disrupt distributed neural networks that underpin cognitive functions, both temporarily and permanently. EE is just one of a number of factors that can affect development in epilepsy. The presence and relative contribution of EE to cognitive impairment is often difficult to separate from that of the underlying etiology or even effects of antiepileptic medication (AEM). This difficulty has led to the increasing use of the term EE to encapsulate "severe" epileptic syndromes, or etiologies associated with severe epilepsy and intellectual disability (ID), regardless of evidence that the epileptic process has impacted cognition. The use of the term EE in the literature to describe both the process of cognitive impairment by epileptic activity and as a category for severe epilepsy syndromes is creating confusion. We propose that use of the term EE be restricted to the central concept of a pervasive epileptic process disrupting development, and that the use of EE as a classifier be avoided. A different term is needed to encapsulate the broad and heterogenous group of patients with severe epilepsy and ID, for which the mechanisms may be unknown but are often closely related to the underlying genetic, metabolic, or structural etiology. An improved understanding of the mechanisms by which EE develops is of critical importance, potentially leading to identification of biomarkers for early detection and treatment.

Seizure Disorders and the Effects of Antiepileptic Medications on Cognitive-Communicative Function

Purpose Review effects of epilepsy and its treatment on cognitive-communicative function. Method We searched PubMed and extracted relevant information. Results Epilepsy is a disorder characterized by recurrent unprovoked seizures. Epilepsy is commonly associated with cognitive disturbances in between seizures, most commonly memory dysfunction. Other cognitive disturbances may be seen, particularly auditory naming when epilepsy starts in the dominant temporal lobe. While control of seizures is expected to improve the cognitive consequences, antiepileptic drugs themselves may be associated with cognitive dysfunction. Among the old generation of antiepileptic drugs, the sedating medications phenobarbital and benzodiazepines have the most negative impact on cognitive function. However, carbamazepine, phenytoin, and valproate may also adversely affect attention and memory. The newer antiepileptic drugs lamotrigine, gabapentin, and levetiracetam (LEV) are less likely to affect cognition than carbamazepine. Another new antiepileptic drug, topiramate, is associated with considerable adverse effects on attention, concentration, memory, executive function, and verbal fluency. Word finding difficulties are a common adverse effect, to the point that some patients can develop a nonfluent aphasia. Levetiracetam (LEV), on the other hand, has been reported to improve verbal fluency in patients with partial epilepsy and language dysfunction. Conclusions Both epilepsy and its treatment may adversely affect cognitive-communicative function.

Epilepsy and its Management in Relation to Psychiatry

The relation between psychiatry and epilepsy remains one of the topics that have been continuously attracting attention in medical literature since the time of Hippocrates. Forced normalization was later conceptualized when biological treatment for psychiatric disorders was developed. Recently, several reports were published regarding possible adverse psychiatric effects of antiepileptic medications. The picture is further complicated by the fact that psychotropic medications, which may be used for treatment of psychiatric disorders in epilepsy, can have negative effects on seizure control. This paper aimed to review psychiatric presentations in individuals with epilepsy and the adverse psychiatric effects of antiepileptic medications. The paper also briefly discusses available treatment options with regards of better psychotropic treatment options. Recent developments in this field led to the observation that psychiatric symptoms, in relation to seizure, can be categorized into the following types pre-ictal, post-ictal, inter-ictal and ictal symptoms. Depression and anxiety are commonly associated with epilepsy and can occur as pre-ictal, ictal, post-ictal or inter-ictal symptoms. Depression can be severe and suicidal behavior has been reported as one of the common psychiatric associations with epilepsy and has also been linked to use of some antiepileptic drugs. Psychosis can occur as an acute or chronic form. Transient pleomorphic postictal psychosis particularly observed in those with hippocampal sclerosis. There is an increased risk of developing schizophrenia and schizophrenia-like psychosis in patients with epilepsy. Psychiatric symptoms can also emerge during use of some of the antiepileptic drugs. Adverse psychiatric events include depression, psychosis, suicidal risk, and cognitive impairment. Some of the psychotropic medications are known to be epileptogenic. Therefore, selection of psychotropic medications should be based on their possible effects on seizures and those known to be epileptogenic should be avoided.

P.1.j.009 Breaking evidence from a human object pattern separation test of disrupted hippocampal dentate gyrus activity in schizophrenics

But extensive assessment by experienced neuropsychologists is hardly feasible in everyday practice for large numbers of patients, especially in outpatient clinics and private practices. This implies a risk of delaying or missing relevant cognitive impairments before and during treatment. Methods: We introduce a computerized screening instrument which allows for standardized assessment of cognitive functions at risk of medication. It was evaluated by standard neuropsychological tests and covers the cognitive domains of attention, cognitive speed, verbal and visual working memory as well as verbal and spatial memory. The test consists of six subtests which take 30 minutes to complete; afterwards the patient’s results are displayed immediately in comparison to age-related normative data. For psychometric evaluation, data were gathered from patients with epilepsy (n = 240), as an example for a chronic neurological disease treated with psychoactive antiepileptic medication (n = 42 untreated, n = 79 monotherapy, n = 119 polytherapy). Results: Comparability to standard neuropsychological tests (0.64 r 0.82) as well as retest reliability (0.40 r 0.79) were shown to be good for the subtests. It could be shown that the screening system is able to detect adverse cognitive effects of antiepileptic medication. Untreated patients showed a generally better performance than those on monotherapy or polytherapy. Comparisons between untreated patients and patients on monotherapy did not differ significantly. Groups of mono-/polytherapy differed significantly (p< 0.05) with lower scores for patients on polytherapy than on monotherapy in most subtests. These differences become even more obvious, as patients on monotherapy did significantly better compared to patients on three or more drugs in most subtests (p< 0.05). Also, the screening demonstrates significant cognitive changes in intra-individual assessment related to titration or withdrawal of antiepileptic drugs (e.g. topiramate). Conclusions: Medicationand dosage-related effects in the individual’s cognitive profile could be demonstrated by the screening instrument, indicating that a regular assessment of these functions, e.g. during change of therapy, is essential to keep track of adverse side effects and to optimize therapeutic interventions in neurological and psychiatric diseases. Also, the necessity of psychoactive drug polytherapy should be well-considered, as it is often associated with severe cognitive impairment. Early detection of deficits facilitates an in time intervention. The introduced screening instrument with its two different versions provides a standardized, time-efficient and individual follow-up assessment of cognitive functions and is valuable for clinical and scientific use.

Association between attention-deficit/hyperactivity disorder and epilepsy in pediatric populations

There is a bidirectional relationship between attention-deficit/hyperactivity disorder (ADHD) and epilepsy. ADHD increases seizure risk, while patients with epilepsy have an increased prevalence of ADHD. The reasons explaining this association are not fully understood. Proposed mechanisms include effects of antiepileptic medications, underlying neurodevelopmental vulnerability, the effects of chronic seizures and subclinical epileptiform activity on cognitive functions and adrenergic dysfunction. There may also be a common genetic defect underlying both disorders in some families. Antiepileptics associated with ADHD-like side effects include phenobarbital, gabapentin, vigabatrin and topiramate. Methylphenidate has been studied in a double-blind setting against placebo for treatment of ADHD comorbid with epilepsy, and has a good risk–benefit ratio. Amphetamine, atomoxetine, clonidine and guanfacine only have case series to support their use and bupropion should be avoided.

Kognition und Epilepsien

It is evident that in chronic epilepsy--both symptomatic and nonsymptomatic--cognitive dysfunction precedes the onset of seizures. Cognitive disorders emerge with the underlying lesion or the concomitant physiological process. The presumed additive effect of seizures has not been decisively clarified. The degree of damage may consecutively accumulate with a disease duration of more than three decades and an unfavorable course with frequent secondary generalized seizures. Long-term follow-up investigation of cognition in different epileptic syndromes is needed to address the question of their specific role in cognitive decline. Treatments successful in seizure control may however also hold cognitive risks. Additional memory impairment due to the surgical treatment of left-sided temporal lobe epilepsy ranks first among them. Cognitive side effects of antiepileptic medication may have considerable adverse effects on patients. The need of individual assessment of cognitive side effects draws increasing attention as a precondition for treatment optimized to each patient.

Effects of antiepileptic medications on psychiatric and behavioral comorbidities in children and adolescents with epilepsy

The three goals of this article are (1) to delineate the limitations in determining the actual incidence of antiepileptic drug (AED) psychiatric and behavioral side effects; (2) to summarize existing data on the direct effects of AEDs on psychiatric and behavioral comorbidities and examine the relationship between these direct effects and specific AED mechanisms of action; and (3) to recognize the indirect effects of AEDs on psychiatric and behavioral medications that can result in aggravation of these comorbidities through drug–drug interactions. All of these data are then combined and formatted into a practical algorithm useful in many clinical situations.

The effects of antiepileptic medications on the social skills of individuals with mental retardation

Prevalence rates of epilepsy are much higher among persons with developmental disabilities compared to the general population. Anticonvulsant medication is the most common method of treating seizure disorders. Many of these antiepileptic medications (AEDs) are associated with various side effects, which may have detrimental effects on the social skills of those with developmental disabilities. The present study investigated the effects of AEDs on the social skills of individuals with mental retardation (MR) residing in an institutional facility. The social skills of 130 individuals were assessed by the Matson Evaluation of Social Skills for Individuals with sEvere Retardation (MESSIER). Sixty-five of these individuals were diagnosed with a seizure disorder and received only one AED at the time of this study. These individuals were taking one of three AEDs (carbamazepine, valproic acid, or phenytoin). Participants belonging to one of these three medication groups were matched with residents for age, gender, level of MR and race, who did not have seizures or receive AEDs. MESSIER scores of each medication group were compared to its respective control group. Those individuals receiving phenytoin presented less positive social skills than their matched counterparts in the phenytoin-control group.

Subject Review: Seizures in the de-institutionalized patients with early brain injuries

The number of individuals with early brain injury and multiple disabilities discharged from institutions has increased steadily over the past 10 years. The most frequently encountered problems by patients with early brain injury and epilepsy placed in the community were reviewed. Unavailability of specialized services, inadequate reimbursement, high turnover and lack of knowledge by caregivers, lack of understanding acceptance of the concepts of seizure intractability and pseudoseizures, unrealistic expectations by overseeing agencies and or family, and side effects of antiepileptic medications were the most common seizure related problems afflicting these patients. Everything else being equal, good exchange of information between the various caregivers and continued education of caregivers, both time consuming endeavours, are the crucial factors for the successful management of seizures in this population.

Sleep and Epilepsy

The differential diagnosis of “things that go bump in the night” includes parasomnias, sleep-related movement disorders, psychiatric conditions, and epilepsy. This article focuses on the interactions between sleep, epilepsy, and the effects of antiepileptic medication, with an emphasis on avoiding misinterpretation of primary sleep disorders and epilepsies presenting during sleep. There are important effects of sleep state on seizure activity, and there are equally important effects of epilepsy on sleep maintenance with implications on daytime alertness. Pointers to elicit appropriate history and examination are described; appropriate investigations including polysomnography and different electro-encephalographic techniques can clarify difficult clinical dilemmas.

Middle latency auditory evoked potentials in epilepsy.

Middle latency auditory evoked potentials (MLAEPs) have been recorded after cortical lesions and seizure surgery. We recorded interictal MLAEPs in 14 patients with well documented complex partial and secondary generalized seizures. Na and Pa potentials did not differ in latency between patients and controls, although both were longer among seizure patients. Pa and Na were significantly reduced in amplitude in complex partial seizure patients compared to controls. These findings accord with previous suggestions that MLAEPs may be generated subcortically but modulated by temporal lobe structures. MLAEPs may be of value in differentiating temporal and extratemporal epilepsy. They may also help clarify interictal cognitive or behavioral symptoms related to epilepsy or the effects of antiepileptic medication.

The children of mothers with epilepsy: Recent trends in research, management and prospect

The last decades have witnessed great changes in the treat­ ment of epilepsy. Improved use of antiepileptic drugs based on the understanding of neuropharmacology, the trend to monotherapy and the de-emphasis on barbitu­ rates have greatly improved the lives of people with epilepsy. Unwillingness to accept continued intractable epilepsy has been a major factor in the worldwide interest in surgical treatment of the partial epilepsies. We have also witnessed some reduction in social prejudice, and residential care for people with epilepsy is now largely an approach of the past. Many epileptic syndromes can now be very successfully treated with full seizure control, although in some, such as juvenile myo­ clonic epilepsy, long-term treatment is still required. An increasing number of women with epilepsy marry and hope to have healthy babies. Their main concerns have been related to inheritance of the epilepsies, and to the effects of antiepileptic medication (AED). The teratogenic effects of these drugs were first recog­ nized almost 30 years ago, although some still hold the view that congenital malformations and developmental abnormalities in the offspring are related to the maternal epilepsy. It is however quite clear that congenital abnor­ malities may be caused by the teratogenic effects of AEDs, and it is surprising how long it has taken for this to become apparent. During the period when this associa­ tion was first recognized, the incidence of malformations was quite high, probably because of specific effects of drugs such as trimethadione, but even more so because of the then widely utilized polypharmacy. In the last decade, there has been a considerable reduc­ tion in the frequency of major congenital malformations overall, and this has been clearly shown by the study of Miyako Oguni and her colleagues [1]. Clearer correlations

Interictal Cognitive Changes in Epilepsy

There is little evidence for significant intellectual deterioration in well-controlled seizure disorders. With recurrent convulsive seizures, the picture is less clear and depends on severity, type, age of onset, and frequency of toxic levels of antiepileptic drugs (see Table 1). In the interictal state, deficits in verbal language and memory have been observed, especially in patients with complex partial seizure foci in the left (dominant) hemisphere. The memory deficits appear to affect new learning and retention of material; the verbal deficits are more subtle, affecting word-finding, verbal fluency, and comprehension abilities. Both of these changes may either go unnoticed by the patient in day to day activities or be attributed to the effects of antiepileptic medication. Antiepileptic drugs can also affect interictal cognitive functioning. The worst of these appears to be phenobarbital; phenytoin has an intermediate effect; valproic acid and carbamazepine as single agents seem to produce fewer adverse effects. However, individual patients may be particularly sensitive to cognitive side effects of certain drugs. Finally, attention deficits and slowing of cognitive processes, either chronically or intermittently, appear to affect all seizure patients to some extent. The syndrome is more prominent in frontal or generalized seizure patterns. The intermittent nature of these disturbances has been emphasized in recent research on subclinical interictal spike-wave electrical phenomena.