Psychological effects of sodium valproate and carbamazepine in epilepsy.

Stores, Gregory; Williams, Patti; Styles, Elizabeth; Zaiwalla, Zenobia

doi:10.1136/adc.67.11.1330

Cited by 77 publications

(62 citation statements)

References 27 publications

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“…Several researchers have concluded that attentional disturbance in these children is the result of the epileptic process itself. Epilepsy and its underlying causes have been postulated to have more negative effects on cognition and behavior than the AEDs used for treatment (9,13,26).…”

Section: Discussionmentioning

confidence: 99%

Does Short‐Term Antiepileptic Drug Treatment in Children Result in Cognitive or Behavioral Changes?

et al. 1998

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Summary:Purpose: To determine possible cognitive and behavioral effects of antiepileptic drug (AED) therapy by assessing children with newly diagnosed epilepsy before and after initiation of treatment. A comparison group of children with diabetes mellitus (DM) was included to control for the effects of practice, maturation, and chronic illness.Methods: Baseline neuropsychological assessments were completed for children with epilepsy (n = 37) and children with DM (n = 26) recruited through outpatient clinics at a regional children's hospital. Children were reevaluated 6 months from baseline testing. At follow-up, children with epilepsy had therapeutic AED levels and controlled seizures. Statistical analysis included a between-group repeated measures ANCOVA with pretest scores serving as the covariate.Results: Significant differences between groups were not found for any cognitive or behavioral factors, including attention (p < 0.24), immediate memory (p < 0.24), delayed memory (p < 0.10), complex motor speed (p < 0.19), or behavior problems (p < 0.89).Conclusions: Changes in performance on cognitive and behavioral measures were not different for children treated with AEDs and controls. Although adverse effects may be associated with prolonged treatment, results would not suggest adverse effects from AED monotherapy during the first 6 months of therapy. Key Words: Pediatrics-AnticonvuIsantsEpilepsy-Cognitive-Behavioral.Cognitive and behavioral effects of antiepileptic drugs (AEDs) remain a critical issue in the treatment of children with epilepsy. As acquisition of academic and social skills is rapid during childhood, adverse effects of AEDs may have a lasting impact on achievement and behavioral outcomes (1). In contrast to adults, children are less able to report effects of AEDs on their learning and behavior (2). Information is needed by parents, whose fears of negative side effects may reduce medical compliance, and by physicians, whose choice of a specific AED includes consideration of both medical efficacy and potential cognitive and behavioral side effects.Research concerning AED effects is marked by inconsistencies and contradictions. Phenobarbital has been the AED most frequently associated with cognitive and behavioral effects in children, including attentional difficulties, paradoxical hyperactivity, decreased short-term memory skills, and conduct disturbances (2-6). However, Mitchell et al. (7) reported minimal dose-related effects on attention, reaction time, and impulsivity at low

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Section: Discussionmentioning

confidence: 99%

Does Short‐Term Antiepileptic Drug Treatment in Children Result in Cognitive or Behavioral Changes?

et al. 1998

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“…Therefore, conclusions about medication effects should not be deduced from these comparisons. 32,33 Improperly controlled between-subject comparisons were even found in studies that also included well-designed within-subject comparisons. 20,21,23 Again, conclusions drawn from these between-subject comparisons are spurious.…”

Section: Lack Of Equivalency In Groups Comparedmentioning

confidence: 99%

“…31,32 Stores et al examined intelligence, focused and sustained attention, memory, visual search ability, and visuomotor coordination in a group of 63 children with newly diagnosed epilepsy. 33 Performance on cognitive measures was assessed at pretreatment and 1, 3, 6, and 12 months after introduction of treatment. A control group of 47 neurologically normal children was included in the study.…”

Section: Carbamazepinementioning

confidence: 99%

Cognitive Effects of “Older” Anticonvulsants in Children with Epilepsy: A Review and Critique of the Literature

Ries

2003

The Journal of Pediatric Pharmacology and Therapeutics

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Cognitive decline in children with seizure disorders is due to several factors, one being the choice of anticonvulsant and total anticonvulsant exposure. This paper reviews research investigating cognitive effects associated with "older" anticonvulsant medications (i.e., phenobarbital, phenytoin, carbamazepine, and valproate) prescribed as monotherapy. A number of cognitive difficulties such as intellectual decline, mild memory loss, visual-motor impairment, and psychomotor slowing have been associated with these medications. Each study included in this review is assessed in terms of the appropriateness of study design and ability of the reader to draw clear conclusions about the cognitive effects associated with the anticonvulsant under investigation. The review also includes a synopsis of the myriad of methodological difficulties that plague this body of literature. Conclusions that can be drawn from the existing literature are delineated, and future directions for research are suggested.

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“…55 In one Class II study, 15 of 163 children assigned to AED withdrew because of intolerable side effects, 56 and in another, children taking PB did not show an expected increase in IQ on retest. 57 In three other studies, which included 48 children taking VPA, 1 taking PHT, and 51 taking CBZ, evidence was not seen of behavioral or cognitive impairment [58][59][60] (see table 5). A report from the American Academy of Pediatrics 44 regarding general recommendations for awareness of behavioral and cognitive effects of AED noted that high blood levels of some AED (PHT, PB, primidone) were significantly related to cognitive decline.…”

Section: What Are the Nature And Frequency Of Side Effects Of Aed Commentioning

confidence: 99%

Practice parameter: Treatment of the child with a first unprovoked seizure

Hirtz¹,

Berg²,

Bettis³

et al. 2003

Neurology

181

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Abstract-The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society develop practice parameters as strategies for patient management based on analysis of evidence regarding risks and benefits. This parameter reviews published literature relevant to the decision to begin treatment after a child or adolescent experiences a first unprovoked seizure and presents evidence-based practice recommendations. Reasons why treatment may be considered are discussed. Evidence is reviewed concerning risk of recurrence as well as effect of treatment on prevention of recurrence and development of chronic epilepsy. Studies of side effects of anticonvulsants commonly used to treat seizures in children are also reviewed. Relevant articles are classified according to the Quality Standards Subcommittee classification scheme. Treatment after a first unprovoked seizure appears to decrease the risk of a second seizure, but there are few data from studies involving only children. There appears to be no benefit of treatment with regard to the prognosis for long-term seizure remission. Antiepileptic drugs (AED) carry risks of side effects that are particularly important in children. The decision as to whether or not to treat children and adolescents who have experienced a first unprovoked seizure must be based on a risk-benefit assessment that weighs the risk of having another seizure against the risk of chronic AED therapy. The decision should be individualized and take into account both medical issues and patient and family preference. NEUROLOGY 2003;60:166 -175 Population-based studies of the incidence of first unprovoked seizures suggest that there are between 25,000 and 40,000 children per year in the United States who experience a first unprovoked seizure. [1][2][3][4] Until relatively recently, it was common practice for physicians to begin long-term, daily antiepileptic drug (AED) therapy after a child or adolescent experienced a single seizure of any type. The rationale for this practice was based on the belief that all seizures were likely to recur and that seizures could be dangerous and cause brain damage. Furthermore, it was thought that if any recurrence were to take place, this would lead to progressively more seizures. It was also assumed that AED were safe, had few side effects, and were effective in prevention of seizure recurrences. These assumptions have undergone substantial modification over the last 20 years, leading to a more optimistic view about the nature of seizures and a more conservative approach to the use of treatment. However, no clear evidence-based guidelines have emerged regarding the initiation of treatment after a first unprovoked seizure in the pediatric population.Practice parameters are developed by the Quality

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Psychological effects of sodium valproate and carbamazepine in epilepsy.

Cited by 77 publications

References 27 publications

Does Short‐Term Antiepileptic Drug Treatment in Children Result in Cognitive or Behavioral Changes?

Does Short‐Term Antiepileptic Drug Treatment in Children Result in Cognitive or Behavioral Changes?

Cognitive Effects of “Older” Anticonvulsants in Children with Epilepsy: A Review and Critique of the Literature

Practice parameter: Treatment of the child with a first unprovoked seizure

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