Impact of Valproate and Phenytoin on Cognitive Function in Elderly Patients: Results of a Single‐Blind Randomized Comparative Study

Abstract

Thirty-eight patients (median age 77 years; range 62-88 years) with elderly-onset seizures were entered into a single-blind, randomized study designed to compare the impact of phenytoin (PHT) and valproate (VPA) on cognitive function. A stratified minimization program matched the two groups for age, sex, and seizure type. Attention, concentration, psychomotor speed, and memory were assessed twice before treatment (to minimize practice effects), at 6 weeks and (for patients remaining in the study) at 3 months, 6 months, and 1 year by an extensive battery of psychologic tests. Changes in cognitive function were minor, and some tended toward improvement. Contrary to expectation, there was little difference between PHT and VPA with regard to impact on cognitive function. Frequent noncognitive adverse effects were reported. Thus, we did not replicate the findings of previous literature. We conclude that antiepileptic drug (AED) monotherapy as used in our trial did not produce significant adverse cognitive effects. The choice of AED in the elderly may therefore be more influenced by consideration of other adverse effects.

Monotherapy versus Polytherapy in Epileptic Adolescents

“…These results were agreed with Mattson et al, 1985 [22], who reported that there was more difficulties in cognitive functions with phenytoin as compared with carbamazepine in partial and secondary generalized seizures. Regarding the psychotic behavior problems there was no significant differences between the three groups, in agreement with studies done by Sabers et al 1995 [23] and Craig and Tallis 1994 [24] who found no differences between antiepileptic drugs as regards their effect on cognitive functions in epileptic adolescents.…”

The cognitive impact of antiepileptic drugs

“…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].…”

The Formation of Cognitive and Mental Disorders in Epilepsy: The Role of Various Factors Associated With Disease and Treatment (A Review of Literature and Case Reports)

“…Тем не менее, в отдельных исследованиях было показано отрица-тельное влияние вальпроата (по выраженности -от легкого до умеренного) на скорость психомоторных реакций и скорость мыслительных процессов [28,29,38,66,81].…”