Cognitive effects of valproate

Gallassi, Roberto; Morreale, Angela; Lorusso, Sebastiano; Procaccianti, Gaetano; Lugaresi, E; Baruzzi, Agostino

doi:10.1016/0920-1211(90)90033-r

Cited by 48 publications

(28 citation statements)

References 9 publications

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“…No differences between patients and controls were detected 1 year after discontinuation of PHT, suggesting a reversible drug effect. Similarly, 20 seizure-free adults performed worse than controls on three measures before discontinuation of VPA monotherapy, and these deficits were completely reversible within 1 year (53).…”

Section: Studies In Patients Whose Medication Is Discontinuedmentioning

confidence: 99%

“…The same group of authors had previously described behavioral disturbances in children treated with PB for febrile seizures (50). Gallassi et al used a discontinuation design to study the effects of PB, CBZ, PHT, and VPA (51)(52)(53). A group of 16 young adults seizure-free on either PB or CBZ monotherapy were tested before, during, and up to 1 year after discontinuation of the medication (5 1).…”

Section: Studies In Patients Whose Medication Is Discontinuedmentioning

confidence: 99%

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Antiepileptic Drugs, Learning, and Behavior in Childhood Epilepsy

Bourgeois

1998

Epilepsia

133

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Summary:Cognitive and behavioral impairments are found more often among epileptic children than among their peers. The cause of these impairments is multifactorial. Identifying the relative contribution of antiepileptic drugs (AEDs) to these problems has been the object of a large number of clinical investigations. This area of research has been characterized by an unusually high number of methodological challenges and pitfalls. Accordingly, results have often been inconsistent and contradictory, except for the more obvious observations that can be derived from clinical experience. Overall, the effects of AEDs on cognition and behavior in children have been overrated in the past. More recent research has benefited from the methodological lessons of previous studies and it suggests that the majority of children taking AEDs do not experience clinically relevant cognitive of behavioral adverse effects from these medications. In addition, some of the newer AEDs may indeed have a better cognitive profile. Nevertheless, clinical experience must be used to identify the subgroup of children who remain at risk for significant and clinically relevant cognitive and behavioral adverse effects of AEDs. Key Words: Epilepsy-Childhood-Antiepileptic drugs-IntelligenceBehavior.Among children and adolescents with epilepsy, the prevalence of cognitive and behavioral disorders is higher than among their nonepileptic peers. There are multiple underlying causes of these cognitive and behavioral abnormalities and they include factors related to the etiology of the epilepsy, ongoing seizure activity, genetics, and treatment, as well as psychosocial issues. It is often difficult to determine the relative contribution of any given factor. This complex interrelation has been the object of several reviews (1-10). Trying to assess the effects of antiepileptic drugs (AEDs) on learning and behavior in patients with epilepsy has revealed itself as being a considerable methodological challenge. The intent of the present review of these effects of AEDs in children with epilepsy is to go beyond an analysis of published neuropsychological investigations and to view the problem from the perspective of its practical relevance and of conventional wisdom in the clinical practice of pediatric epileptology. this area? (a) Undoubtedly, within a clinical practice, one will notice that a disproportionate percentage of children with epilepsy have learning and behavioral problems. Sometimes, based on their time course, these problems can be attributed to antiepileptic medication, but more often the relationship is blurred or nonexistent and problems precede the introduction of the very first AED. (b) Parents of children whose AEDs are temporarily discontinued for the purpose of presurgical monitoring are at times amazed at how much more alert and more responsive their child has suddenly become. (c) However, the same observation is reported by parents of children who have become seizure-free following epilepsy surgery, but whose AED regimen is exactly the same...

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Section: Studies In Patients Whose Medication Is Discontinuedmentioning

confidence: 99%

Section: Studies In Patients Whose Medication Is Discontinuedmentioning

confidence: 99%

Antiepileptic Drugs, Learning, and Behavior in Childhood Epilepsy

Bourgeois

1998

Epilepsia

133

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“…One double-blind, placebo-controlled study reported more convincing evidence of improved motor skills after discontinuation [Duncan et al 1990]. Fortunately, the CAEs associated with valproate are likely to be reversible [Galassi et al 1990].…”

Section: Sodium Valproate and Ethosuximidementioning

confidence: 99%

“…Word-finding difficulties in particular have been linked to the presence of simple partial seizures and left temporal EEG focus [Mula et al 2003b]. There is little evidence that patients with a longer history of epilepsy are more likely to be susceptible to CAEs with sodium valproate [Ristic et al 2006;Galassi et al 1990], although duration of drug intake has been shown to be a related factor for CAEs with carbamazepine [Shehata et al 2009]. Age has sometimes been shown to be unrelated to the presence of CAEs [Ristic et al 2006], but is likely to play a role in the expression of cognitive difficulties, and one complicating factor in the examination of age effects is the use of differing instruments with individuals of different age groups.…”

Section: Implications For Clinical Practicementioning

confidence: 99%

The cognitive impact of antiepileptic drugs

Eddy¹,

Rickards²,

Cavanna³

2011

Ther Adv Neurol Disord

319

189

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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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“…19 Seizure reduction as well as discontinuation of AED therapy were both shown to have significant effects on improving cognition and other neuropsychological abilities. 9,11 In the presented series, 59.1% of all patients were successfully weaned from AEDs. Overall, interdisciplinary counseling of pediatric patients with CCM-associated epilepsy should lead to early epilepsy surgery.…”

mentioning

confidence: 97%

Surgical management and long-term outcome of pediatric patients with different subtypes of epilepsy associated with cerebral cavernous malformations

Kuczaty

Lehe²

2014

PED

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Object Sufficient data on surgical treatment and seizure outcome of pediatric patients with different types of epilepsy, especially drug-resistant epilepsy and associated cerebral cavernous malformations, are scarce. The aim of this study was to carefully evaluate seizure outcome using the International League Against Epilepsy (ILAE) classification with regard to the presurgical symptom duration. Methods Fifty-one pediatric patients younger than 19 years with cerebral cavernous malformations of all CNS localizations have been surgically treated at the authors' institution. Twenty-two patients with seizures or epilepsy who harbored cortically located supratentorial cerebral cavernous malformations underwent surgical treatment and were retrospectively analyzed. Results More extensive resections were used in 82% of all patients with epilepsy symptoms for longer than 2 years. Eighty-two percent of patients with symptom duration shorter than 2 years underwent circumscribed lesionectomy including the surrounding hemosiderotic rim. The overall rate of mild permanent, unanticipated postoperative deficits was 4.5%; the rate of anticipated neurological deficits was 9%. The mean follow-up was longer than 117 months in all groups. Seizure outcome was excellent in the group with symptom duration shorter than 2 years (100% ILAE Class 1). Seizure outcome was significantly worse in the group with longer symptom duration (p = 0.02). Seven patients were seizure free after surgery. Seizure outcome was stable over the years. Conclusions Since seizure outcome is worse with longer seizure duration, early surgery and, if needed, interdisciplinary intervention, is recommended. Even in cases of multiple cerebral cavernous malformations and epilepsy, surgery should be considered.

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Cognitive effects of valproate

Cited by 48 publications

References 9 publications

Antiepileptic Drugs, Learning, and Behavior in Childhood Epilepsy

Antiepileptic Drugs, Learning, and Behavior in Childhood Epilepsy

The cognitive impact of antiepileptic drugs

Surgical management and long-term outcome of pediatric patients with different subtypes of epilepsy associated with cerebral cavernous malformations

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