SUMMARY A battery of psychometric tests was administered to 85 patients with epilepsy, of whom 26 were untreated, 40 received carbamazepine monotherapy and 19 took carbamazepine with another anticonvulsant. Carbamazepine alone had little effect on performance, but carbamazepine polypharmacy produced significant impairment. Increasing concentrations of carbamazepine (four tests) and its active metabolite, carbamazepine 10,1 1 epoxide (seven tests), correlated with decreasing performance in the monotherapy patients.Since the epidemiological studies of the 1950s, an association has been established between seizure disorders and neuropsychological deficit.' 2 The complex relationship between fits, cognitive impairment, psychosocial difficulties and underlying cerebral pathology has been the subject of several recent investigations.3 The tangle of causality between these four factors has not been fully unravelled. Since the first controlled study of Reynolds and Travers,6 there has been a growing body of evidence that a fifth factor, the presence of antiepileptic drugs in the brain, contributes independently to disruption of intellectual functioning. Thompson and Trimble7 and Ludgate and his colleagues8 have shown that patients receiving multiple anticonvulsants function less well on cognitive testing than those treated with monotherapy and that reducing the number ofcirculating drugs can lead to improvement in performance without producing a deterioration in seizure control.Patients taking carbamazepine appear to show less evidence of cerebral impairment than those treated with older agents such as phenytoin or phenobarbitone.9Y'1 However, Macphee and co-workers, in a recent series of studies using a battery of simple psychomotor tests, have demonstrated that subtle derangement can be produced in naive subjects
Records of coma and post-traumatic amnesia (PTA) were collected for a group of 38 patients with closed head injury. The results confirmed earlier studies indicating that patients may have short or negligible coma but report prolonged PTA. Comparison of eight patients with prolonged PTA (>7 days) and short coma (<6 hours) with the rest of the group on MRI in the acute stage showed that these patients had significantly more extensive hemispheric damage. In the group as a whole both coma and PTA were related to the number of areas in central brain structures in which lesions were detected, but only PTA was significantly related to the number of hemispheric areas in which lesions were found. It is concluded that although both coma and PTA are related to brain damage they reflect disparate patterns of lesions. Assessment of PTA can thus provide additional information concerning severity of inury.(C Neurol Neurosurg Psychiatry
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