Evaluation of the effects of vigabatrin on cognitive abilities and quality of life in epilepsy

Dodrill, Carl B.; Arnett, John L.; Sommerville, Kenneth W.; Sussman, Neil M.

doi:10.1212/wnl.43.12.2501

Cited by 69 publications

(41 citation statements)

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“…Patients who attained TGB monotherapy improved in the areas of adjustment and mood (67), a change attributable most likely to discontinuation of previous AEDs. Similarly, several investigations of the cognitive and behavioral effects of VGB have shown no or only minimal impairment, and even some evidence of improvement (68)(69)(70)(71)(72). Psychosis and depression have been repeatedly described with VGB, both in adults and in children (73)(74)(75).…”

Section: Newer Aedsmentioning

confidence: 93%

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: Newer Aedsmentioning

confidence: 93%

Antiepileptic Drugs, Learning, and Behavior in Childhood Epilepsy

Bourgeois

1998

Epilepsia

133

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“…Vigabatrin has demonstrated few CAEs when compared with placebo in double-blind studies [Dean et al 1999;Dodrill et al 1993;Gillham et al 1993] and fewer adverse effects than carbamazepine in a small, open-label, randomized, parallel-group study . Vigabatrin had no detrimental effects on cognitive functions at 12 months, and memory retrieval and mental flexibility improved significantly.…”

Section: Vigabatrinmentioning

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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“…Only three studies stated the method of randomization, and only one study reported the use of an intention-totreat analysis. Add-on therapy is by nature a heterogeneous treatment category; however, many placebo- controlled add-on trials described subjects' background treatment as "no more than two currently marketed antiepilepsy drugs" (10) or "combinations of drugs" (1 1). To test cognitive effects, many studies used a multitude of neuropsychological tests, the most frequently used of which are listed in Tables 5, 6, and 7, respectively.…”

Section: Resultsmentioning

confidence: 99%

Neuropsychological Outcomes in Randomized Controlled Trials of Antiepileptic Drugs: A Systematic Review of Methodology and Reporting Standards

et al. 1998

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Summary:Purpose: To systematically review the methodology and use of neuropsychological tests in randomized controlled trials (RCTs) of antiepileptic drugs (AEDs) in patients with epilepsy.Methods: Trial reports were found by searching Medline 1966-1 996 and searching through journals by hand. Inclusion and exclusion criteria were applied, and methodological and neuropsychological test data was extracted by using a proforma.Results: 43 reports met our inclusion criteria, representing 40 RCTs, as three RCTs had generated two reports. Twenty-two were actively controlled, and 18 were placebo-controlled studies. Reporting of basic methods such as randomization method was poor. There has been no uniform approach to the use of neuropsychological tests, and a total of 87 has been used. The Stroop Colour Word Test and the Finger Tapping Test were most commonly used, at 13 times each, but were not used or reported in a uniform manner.Conclusions: Poor reporting of methods and the use of a plethora of neuropsychological tests create great difficulties for anyone wishing to make sense of currently available data. If we are better to understand the neuropsychological effects of AEDs, a more rational approach is needed, for which recommendations are made.

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Evaluation of the effects of vigabatrin on cognitive abilities and quality of life in epilepsy

Cited by 69 publications

References 0 publications

Antiepileptic Drugs, Learning, and Behavior in Childhood Epilepsy

Antiepileptic Drugs, Learning, and Behavior in Childhood Epilepsy

The cognitive impact of antiepileptic drugs

Neuropsychological Outcomes in Randomized Controlled Trials of Antiepileptic Drugs: A Systematic Review of Methodology and Reporting Standards

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