Carbamazepine and phenytoin in epilepsies refractory to barbiturates: efficacy, toxicity and mental function

Bittencourt, P. R. M.; Antoniuk, Sérgio Antônio; Bigarella, Mônica M.; Costa, Jaderson Costa da; Dóro, Maribel Pelaez; Ferreira, Zulma S.; Fonseca, Lineu Corrêa; Gorz, Ana M.; Silva, G.E. Gonçalves e; Marcourakis, Tânia; Tedros, G.M.A.S.

doi:10.1016/0920-1211(93)90029-7

Cited by 18 publications

(4 citation statements)

References 10 publications

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“…However, this study had a before-after comparison design [9], and found about two-thirds of the patients to be seizure free during the 6-month study period, with better efficacy in secondarily generalized seizures. The trial did not report differential efficacy or PHT versus CBZ as an outcome, and hence remains uninformative [9]. …”

Section: Resultsmentioning

confidence: 99%

Pharmacotherapy of Focal Epilepsy in Children: A Systematic Review of Approved Agents

Arya

Glauser

2013

CNS Drugs

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Background Partial-onset seizures contribute the bulk of seizure burden in childhood epilepsy. The therapeutic decision making involves consideration of factors specific to drug, patient and socioeconomic situation. Objectives This paper systematically reviews the available efficacy/effectiveness evidence for various anti-epileptic drugs (AED) as monotherapy and adjunctive therapy for partial-onset seizures in children. Data sources Relevant randomized clinical trials (RCTs) were identified by a structured PubMed search, supplemented by an additional hand search of reference lists and authors’ files. Study appraisal and synthesis methods Eligible studies were reviewed and data extracted into tables. Included RCTs were classified based on accepted published criteria. Outcomes Only efficacy and effectiveness outcome measures were evaluated since there is little scientifically rigorous comprehensive AED adverse effects data. Results Oxcarbazepine is the only AED with Class I evidence for efficacy/effectiveness as initial monotherapy for partial-onset seizures in children. Carbamazepine, clobazam, lamotrigine, phenobarbital, phenytoin, topiramate, valproate, vigabatrin and zonisamide have, at best, Class III efficacy/effectiveness evidence for monotherapy of partialonset seizures in children. For adjunctive therapy, gabapentin, lamotrigine, levetiracetam, oxcarbazepine and topiramate have Class I efficacy/effectiveness evidence for treatment of pediatric partial-onset seizures. Conclusions and implications of key findings This efficacy/effectiveness analysis must not be used in isolation when selecting therapy. AED selection for a specific child needs to integrate a drug’s efficacy/effectiveness data with its safety and tolerability profile, pharmacokinetic properties, available formulations, and patient specific characteristics. It is critical that physicians and patients incorporate all these relevant variables when choosing AED therapy.

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Section: Resultsmentioning

confidence: 99%

Pharmacotherapy of Focal Epilepsy in Children: A Systematic Review of Approved Agents

Arya

Glauser

2013

CNS Drugs

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“…Despite reported CAEs, Pulliainen and Jokelainen concluded that the long-term effects of phenytoin on cognition are relatively few and Therapeutic Advances in Neurological Disorders 4 (6) restricted mainly to some visually guided motor functions [Pulliainen and Jokelainen, 1995]. More favourable findings include minimal cognitive effects in children [Forsythe et al 1991] and elderly patients [Craig and Tallis, 1994], improvements in Stroop performance in partial epilepsy [Bittencourt et al 1993], no differences on tasks assessing verbal and performance intelligence, memory and visuomotor function, before and after treatment in drug-naïve adult patients [Sudhir et al 1995] and a similar cognitive profile to oxcarbazepine [Aikiä et al 1992].…”

Section: Phenytoinmentioning

confidence: 99%

“…For example, one study showed that story recall improved in children with benign rolandic epilepsy when treated with carbamazepine [Seidel and Mitchell, 1999]. Other beneficial effects on memory include improved immediate memory and late recall [Bittencourt et al 1993] and better retrieval from episodic and semantic memory in adults and adolescents . There may be a mild beneficial effect on hand-eye coordination in children with complex partial epilepsy in addition to improvements in memory [O'Dougherty et al 1987].…”

Section: Phenytoinmentioning

confidence: 99%

“…More favourable findings include minimal cognitive effects in children [Forsythe et al 1991] and elderly patients [Craig and Tallis, 1994], improvements in Stroop performance in partial epilepsy [Bittencourt et al 1993], no differences on tasks assessing verbal and performance intelligence, memory and visuomotor function, before and after treatment in drug-naïve adult patients [Sudhir et al 1995] and a similar cognitive profile to oxcarbazepine [Aikiä et al 1992].…”

Section: Phenytoinmentioning

confidence: 99%

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The cognitive impact of antiepileptic drugs

Eddy¹,

Rickards²,

Cavanna³

2011

Ther Adv Neurol Disord

301

175

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Effective treatment of epilepsy depends on medication compliance across a lifetime, and studies indicate that drug tolerability is a significant limiting factor in medication maintenance. Available antiepileptic drugs (AEDs) have the potential to exert detrimental effects on cognitive function and therefore compromise patient wellbeing. On the other hand, some agents may serve to enhance cognitive function. In this review paper, we highlight the range of effects on cognition linked to a variety of newer and older AEDs, encompassing key alterations in both specific executive abilities and broader neuropsychological functions. Importantly, the data reviewed suggest that the effects exerted by an AED could vary depending on both patient characteristics and drug-related variables. However, there are considerable difficulties in evaluating the available evidence. Many studies have failed to investigate the influence of patient and treatment variables on cognitive functioning. Other difficulties include variation across studies in relation to design, treatment group and assessment tools, poor reporting of methodology and poor specification of the cognitive abilities assessed. Focused and rigorous experimental designs including a range of cognitive measures assessing more precisely defined abilities are needed to fill the gaps in our knowledge and follow up reported patterns in the literature. Longitudinal studies are needed to improve our understanding of the influence of factors such as age, tolerance and the stability of cognitive effects. Future trials comparing the effects of commonly prescribed agents across patient subgroups will offer critical insight into the role of patient characteristics in determining the cognitive impact of particular AEDs.

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