The influence of antiepileptic drugs on cognitive function of epileptic patients_Journal of Epilepsy

Authors：

WANG Lei ¹ , LIN Wanhui ^1,2 ,  HUANG Huapin ^1,3

1. Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou 350001, China;
2. Department of Geriatrics,Union Hospital of Fujian Medical University, Fuzhou 350001, China;
3. Fujian Key Laboratory of Molecular Neurology, Fuzhou 350001, China;

Corresponding author：

HUANG Huapin, Email: hh-p@163.com

Keywords：

Epilepsy; Cognitive function; Antiepileptic drugs; Clinical memory scale

DOI：

10.7507/2096-0247.20180019

Video：

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Objective To investigate the changes of cognitive function of epileptic patients after antiepileptic drugs (AEDs) therapy. Methods Twenty eight cases of epileptic patients with new diagnosis and untreatment from March 2015 to February 2016 were collected. According to the seizure type, degree of attack and drug efficacy, patients were divided into three groups and treated with one of three AEDs, including Lamotrigine (LTG), Oxcarbazepine (OXC), and Sodium valproate (VPA). Among them, 11 were LTG group, 12 were OXC group and 5 were VPA group.Then the patients were followed up for 1 year. The clinical memory scale was used to analyze cognitive function of epileptic patients before and after therapy. Results Compared to 30 cases of healthy volunteers, the scores of memory quotient (P<0.01), directed memory (P<0.05), associative learning (P<0.05) and image free recall (P<0.01) of epileptic patients were obviously decreased before AEDs therapy.AEDs therapy reduced or controlled seizures in new diagnostic epileptic patients, and the total effective rate was 85.7%. In the clinical memory scale tests, the scores of memory quotient (P<0.01), directed memory (P<0.05), associative learning (P<0.05), portrait characteristics contact memory (P<0.05) were improved after therapy. The scores of image free recall and meaningless graphics recognition were also improved, but there was no statistical significance. Besides, there was a statistically significant improvement in the score of portrait characteristics contact memory after LTG treatment (P<0.05), and directed memory after VPA treatment (P<0.05). Conclusions Epileptic patients accompanied with cognitive deficits before drug intervention. Through standard AEDs treatment, seizures could be better controlled. The cognitive function of epileptic patients was not declined after short-term（within 1 year） intervention of LTG, OCX or VPA. Moreover some parts of the cognitive domain could be improved.

Citation： WANG Lei, LIN Wanhui, HUANG Huapin. The influence of antiepileptic drugs on cognitive function of epileptic patients. Journal of Epilepsy, 2018, 4(2): 89-93. doi: 10.7507/2096-0247.20180019 Copy

1.	England MJ, Liverman CT, Schultz AM, et al. Epilepsy across the spectrum: promoting health and understanding. a summary of the institute of medicine report.. Epilepsy Behav, 2012, 25(2): 266-276.
2.	Taylor J, Baker GA. Newly diagnosed epilepsy: Cognitive outcome at 5 years. Epilepsy Behav, 2010, 18(4) : 397-403.
3.	Helmstaedter C, Witt JA. Clinical neuropsychology in epilepsy: theoretical and practical issues. Handb Clin Neurol, 2012, 107: 437-459.
4.	Bootsma HP, Vos AM, Hulsman J, et al. Lamotrigine in clinical practice: Long-term experience in patients with refractory epilepsy referred to a tertiary epilepsy center. Epilepsy Behav, 2008, 12(2): 262-268.
5.	IJff DM, van Veenendaal TM, Majoie HJ, et al. Cognitive effects of lacosamide as adjunctive therapy in refractory epilepsy. Acta Neurol Scand, 2015, 131(6): 347-354.
6.	Tzitiridou M, Panou T, Ramantani G, et al. Oxcarbazepine monotherapy in benign childhood epilepsy with centrotemporal spikes: a clinical and cognitive evaluation. Epilepsy Behav, 2005, 7(3): 458-467.
7.	Donati F, Gobbi G, Campistol J, et al. The cognitive effects of oxcarbazepine versus carbamazepine or valproate in newly diagnosed children with partial seizures. Seizure, 2007, 16(8): 670-679.
8.	Sun W, Wang Y, Wang W, et al. Attention changes in epilepsy patients following 3-month topiramate or valproate treatment revealed by event-related potential. Int J Psychophysiol, 2008, 68(3): 235-241.
9.	Jellett AP, Jenks K, Lucas M, et al. Standard dose Valproic acid does not cause additional cognitive impact in a rodent model of intractable epilepsy. Epilepsy Res, 2015, 110: 88-94.
10.	中国抗癫痫协会. 临床诊疗指南癫痫病分册 (2015 修订版). 北京: 人民卫生出版社. 2015: 15-19.
11.	Rathouz PJ, Zhao Q, Jones JE, et al. Cognitive development in children with new onset epilepsy. Dev Med Child Neurol, 2014, 56(7): 635-641.
12.	Kellermann TS, Bonilha L, Lin JJ. Mapping the landscape of cognitive development in children with epilepsy. Cortex, 2015, 66: 1-8.
13.	Witt JA, Helmstaedter C. Should cognition be screened in new-onset epilepsies? A study in 247 untreated patients. J Neurol, 2012, 259(8): 1727-1731.
14.	Witt JA, Werhahn KJ, Kramer G, et al. Cognitivebehavioral screening in elderly patients with new-onset epilepsy before treatment. Acta Neurol Scand, 2014, 130 (3): 172-177.
15.	Voltzenlogel V, Vignal JP, Hirsch E, et al. The influence of seizure frequency on anterograde and remote memory in mesial temporal lobe epilepsy. Seizure, 2014, 23(9) : 792-798.
16.	Blum D, Meador K, Biton V, et al. Cognitive effects of lamotrigine compared with topiramate in patients with epilepsy. Neurology, 2006, 67(3): 400-406.
17.	Meador KJ, Loring DW, Vahle VJ, et al. Cognitive and behavioral effects of lamotrigine and topiramate in healthy volunteers. Neurology, 2005, 64(12): 2108-2114.
18.	Ristic AJ, Vojvodic N, Jankovic S, et al. The frequency of reversible parkinsonism and cognitive decline associated with valproate treatment: A study of 364 patients with different types of epilepsy. Epilepsia, 2006, 47(12): 2183-2185.

1. England MJ, Liverman CT, Schultz AM, et al. Epilepsy across the spectrum: promoting health and understanding. a summary of the institute of medicine report.. Epilepsy Behav, 2012, 25(2): 266-276.
2. Taylor J, Baker GA. Newly diagnosed epilepsy: Cognitive outcome at 5 years. Epilepsy Behav, 2010, 18(4) : 397-403.
3. Helmstaedter C, Witt JA. Clinical neuropsychology in epilepsy: theoretical and practical issues. Handb Clin Neurol, 2012, 107: 437-459.
4. Bootsma HP, Vos AM, Hulsman J, et al. Lamotrigine in clinical practice: Long-term experience in patients with refractory epilepsy referred to a tertiary epilepsy center. Epilepsy Behav, 2008, 12(2): 262-268.
5. IJff DM, van Veenendaal TM, Majoie HJ, et al. Cognitive effects of lacosamide as adjunctive therapy in refractory epilepsy. Acta Neurol Scand, 2015, 131(6): 347-354.
6. Tzitiridou M, Panou T, Ramantani G, et al. Oxcarbazepine monotherapy in benign childhood epilepsy with centrotemporal spikes: a clinical and cognitive evaluation. Epilepsy Behav, 2005, 7(3): 458-467.
7. Donati F, Gobbi G, Campistol J, et al. The cognitive effects of oxcarbazepine versus carbamazepine or valproate in newly diagnosed children with partial seizures. Seizure, 2007, 16(8): 670-679.
8. Sun W, Wang Y, Wang W, et al. Attention changes in epilepsy patients following 3-month topiramate or valproate treatment revealed by event-related potential. Int J Psychophysiol, 2008, 68(3): 235-241.
9. Jellett AP, Jenks K, Lucas M, et al. Standard dose Valproic acid does not cause additional cognitive impact in a rodent model of intractable epilepsy. Epilepsy Res, 2015, 110: 88-94.
10. 中国抗癫痫协会. 临床诊疗指南癫痫病分册 (2015 修订版). 北京: 人民卫生出版社. 2015: 15-19.
11. Rathouz PJ, Zhao Q, Jones JE, et al. Cognitive development in children with new onset epilepsy. Dev Med Child Neurol, 2014, 56(7): 635-641.
12. Kellermann TS, Bonilha L, Lin JJ. Mapping the landscape of cognitive development in children with epilepsy. Cortex, 2015, 66: 1-8.
13. Witt JA, Helmstaedter C. Should cognition be screened in new-onset epilepsies? A study in 247 untreated patients. J Neurol, 2012, 259(8): 1727-1731.
14. Witt JA, Werhahn KJ, Kramer G, et al. Cognitivebehavioral screening in elderly patients with new-onset epilepsy before treatment. Acta Neurol Scand, 2014, 130 (3): 172-177.
15. Voltzenlogel V, Vignal JP, Hirsch E, et al. The influence of seizure frequency on anterograde and remote memory in mesial temporal lobe epilepsy. Seizure, 2014, 23(9) : 792-798.
16. Blum D, Meador K, Biton V, et al. Cognitive effects of lamotrigine compared with topiramate in patients with epilepsy. Neurology, 2006, 67(3): 400-406.
17. Meador KJ, Loring DW, Vahle VJ, et al. Cognitive and behavioral effects of lamotrigine and topiramate in healthy volunteers. Neurology, 2005, 64(12): 2108-2114.
18. Ristic AJ, Vojvodic N, Jankovic S, et al. The frequency of reversible parkinsonism and cognitive decline associated with valproate treatment: A study of 364 patients with different types of epilepsy. Epilepsia, 2006, 47(12): 2183-2185.

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