Side Effects Of Antiepileptic Drugs Treatment Research Articles

Evaluating the mediating role of executive functions for antiepileptic drugs' effects on IQ in children and adolescents with epilepsy

Several studies suggest that antiepileptic drug (AED) treatment may permanently or reversibly affect intelligence (intelligence quotient [IQ]) in children and adolescents with epilepsy. Since AED treatment preferentially affects attention and executive functions, we evaluated the potentially mediating effect of executive functions in regard to the adverse effects of drug treatment on intelligence.In a retrospective observational study, 178 children and adolescents with refractory and mostly localization-related epilepsies were evaluated in regard to the interrelation of IQ (Wechsler Intelligence Scale for Children [WISC III] short-form), executive functions (EpiTrack-Junior®, a cognitive AED screening test), and drug treatment (drug load).The results indicate that a low IQ was evident in 23%, impaired executive functions in 59% of the patients. Executive functions correlated to IQ (r = 0.60) and the symbol digits and picture arrangement subtests (R2 = 0.46) in particular. Odds ratios for impaired executive functions compared to being off drug (33% impaired) increased from 2.0 with one drug (53% impaired) to 9.5 (83% impaired) with at least three drugs. A mediation analysis revealed that drug dependent differences in executive functions mediate the negative effect of the AED load on intelligence.Hence, executive functions appear to link adverse cognitive side effects of AED treatment to intelligence. Considering Catell's two factor model of intelligence, AEDs preferentially affect the aspects of fluid intelligence. The overall impact of AED on intelligence appears mild. It may become relevant, however, when drug-induced impairments persist over longer time intervals during sensitive developmental phases. This issue needs to be addressed in future longitudinal studies.

Subjectively Perceived Side-Effects of Anti-Epileptic Drugs in Chronic Refractory Epilepsy

Purpose: Antiepileptic drugs (AEDs) can cause side-effects. Patient-reported side-effects due to this type of medication are very common, but thus far only investigated in community based populations. We investigated the subjectively perceived side-effects of anti-epileptic drug treatment in patients with refractory epilepsy. Methods: A non-selected group, of patients visiting the outpatient department between September 2011 and November 2011 was invited to complete a questionnaire only if they had experienced side-effects of their AED treatment during last year. The questionnaire, the SIDAED, assessed four different categories; cognition, mood, cosmetics and general health. Subgroup analyses were based on their medication use: mono- or polytherapy, older and newer AEDs and AEDs with a high or a low risk for cognitive and behavioral/mood side-effects. Results: In total, 203 patients or their relatives completed the questionnaire. Mean age of the patients was 37 years (2-81). Most reported complaints (85%) were about their general health followed by cognition, mood and cosmetics. Subgroup analyses showed no differences between patients using monotherapy or polytherapy. Also, no differences were found between patients using older AEDs or newer drugs. Patients using AEDs with a high risk for side-effects did complain more about their mood but not about their cognition. Regression analysis showed that using a high risk AED for behavioral side-effects contributed significantly to the total experienced side-effects. Conclusion: In conclusion, our study illustrates that patients are a reliable respondent to indicate side-effects despite of their refractory epilepsy. Particularly, mood complaints due to antiepileptic drugs (such as levetiracetam) are correctly noticed.

Suicidality in Epilepsy and Possible Effects of Antiepileptic Drugs

Suicide is an important cause of premature death, and people with epilepsy are thought to be at increased risk for suicide. Antiepileptic drugs (AEDs) continue to be the mainstay of epilepsy treatment, but the benefits of seizure control must be balanced with their psychotropic potential. In recent years, suicidality has been recognized as a complication of several groups of drugs and, most recently, AEDs were implicated in an alert by the US Food and Drug Administration. The risk of suicidal ideation and behavior as side effects of AED treatment is low, and in people with epilepsy, such a risk must be balanced against the risk of not treating the seizures.

The effects of antiepileptic drugs on classroom performance

AbstractEpilepsy is one of the most common neurological disorders in children, and it has been associated with an increased risk of cognitive, psychiatric, and learning problems. Although side effects of antiepileptic drugs (AEDs) have been long studied in adults, an understanding of how they manifest in children is only beginning to emerge. Careful clinical considerations must be made to accurately determine the potential contribution of AEDs to learning problems, and this includes understanding the complex role played by multiple medical, developmental, and psychosocial factors. The present review provides information on common cognitive and psychiatric side effects of AED treatment in children, with consideration of classroom accommodations and strategies that may be helpful to circumvent these difficulties. © 2009 Wiley Periodicals, Inc.

Seizures and therapy in adolescents with uncomplicated epilepsy

Purpose: This study aimed to describe seizures and their therapy among Swedish adolescents, aged 13–22, with active but uncomplicated epilepsy. Method: The adolescents answered questionnaires (158/193). Data were also obtained from medical records. Results: Epileptic seizure types could be specified in 92.1% of the cases. Predominant types were Primary Generalised Tonic–Clonic Seizures and Partial Complex Seizures with Secondary Generalisation. Clinical diagnoses by physicians were unspecified in 25.8%. Ninety percent were on antiepileptic drugs (AEDs), most commonly valproate and carbamazepine. New AEDs were used in 9.3% of the cases and polytherapy in 13.9%. More than 40% of the respondents had seizures despite AED treatment. Side effects of AEDs were experienced by 61%, most commonly tiredness, concentration difficulties and headache. Patients on polytherapy experienced significantly more side effects. The choice of a new AED over a traditional one was not related to seizure type or seizure control. Conclusions: Many adolescents had persistent seizures despite treatment at a specialist regional epilepsy centre. This, plus the high reported rate of side effects of AED treatment, suggests that treatment is not optimal for the group studied. As traditional AEDs strongly dominated treatment possibly newly marketed AEDs are underused in this group.

Clinimetrics and epilepsy care

In order to study the practicability of rating scales in the regular care of people with epilepsy, indices have been developed and tested on their validity. These indices consist of the Index of Seizures, representing seizure activity, and the Composite Index of Impairment concerning the severity of impairment caused by the seizure type and frequency and the side-effects of anti-epileptic drug treatment. The indices have been applied in a retrospective quantitative evaluation of anti-epileptic drug therapy. The medical records of 250 randomly selected patients registered at an adult out-patient clinic have been reviewed. Their seizures have been classified as generalized tonic-clonic, simple partial and/or complex partial. The distribution of this population according to these indices has been studied, which leads us to the following conclusions: the global indices are valid for clinical application; in 18.6% of the patients studied there was severe impairment and unacceptable seizure control; combined types of seizure are difficult to control; no significant difference is demonstrated between monotherapy and polytherapy regarding the amount of neurotoxicity. The indices can be determined rapidly and therefore may become valuable aids for the physician in an out-patient clinic to support a decision whether or not to revise current anti-epileptic drug therapy.