The Cognitive Profile of Ethosuximide in Children

IJff, Dominique M.; Veenendaal, Tamar M. van; Hall, Mariette H. Debeij-van; Jansen, Jacobus F.A.; Louw, A.J.A. de; Majoie, Marian; Aldenkamp, Albert P.

doi:10.1007/s40272-016-0187-z

Cited by 18 publications

(10 citation statements)

References 14 publications

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“…Despite absence epilepsy (AE) being defined a “benign” disorder, a high rate of initial treatment failure, associated therapeutic side effects, development of generalized tonic-clonic seizures and psychosocial co-morbidities in more recent reports emphasize its real burden (Bouma, Westendorp, van Dijk, Peters, & Brouwer, 1996; Caplan et al, 2008; Cnaan et al, 2017; Glauser et al, 2010; IJff et al, 2016; Loughman, Bendrups, & D'Souza, 2016; Masur et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Towards a Better Understanding of Cognitive Deficits in Absence Epilepsy: a Systematic Review and Meta-Analysis

et al. 2019

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Cognition in absence epilepsy (AE) is generally considered undisturbed. However, reports on cognitive deficits in AE in recent years have suggested otherwise. This review systematically assesses current literature on cognitive performance in children with AE. A systematic literature search was performed in Pubmed, Embase, Cochrane and Web of Science. All studies reporting on cognitive performance in children with AE were considered. In total 33 studies were eligible for inclusion. Neuropsychological tests were classified into the following domains: intelligence; executive function; attention; language; motor & sensory-perceptual examinations; visuoperceptual/visuospatial/visuoconstructional function; memory and learning; achievement. Random-effect meta-analyses were conducted by estimating the pooled mean and/or pooling the mean difference in case-control studies. Full-scale IQ in children with AE was estimated at 96.78 (95%CI:94.46–99.10) across all available studies and in case-control studies IQ was on average 8.03 (95%CI:-10.45- -5.61) lower. Verbal IQ was estimated at 97.98 (95%CI:95.80–100.16) for all studies and 9.01 (95%CI:12.11- -5.90) points lower in case-control studies. Performance IQ was estimated at 97.23 (93.24–101.22) for all available studies and 5.32 (95%CI:-8.27–2.36) points lower in case-control studies. Lower performance was most often reported in executive function (cognitive flexibility, planning, and verbal fluency) and attention (sustained, selective and divided attention). Reports on school difficulties, neurodevelopmental problems, and attentional problems were high. In conclusion, in contrast to common beliefs, lower than average neurocognitive performance was noted in multiple cognitive domains, which may influence academic and psychosocial development.Electronic supplementary materialThe online version of this article (10.1007/s11065-019-09419-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Towards a Better Understanding of Cognitive Deficits in Absence Epilepsy: a Systematic Review and Meta-Analysis

et al. 2019

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“…The main limitation of this study is the sample size, which limits the power for more in‐depth correlation analysis with clinical/epilepsy variables, for which we did not find a relation. Furthermore, it cannot be excluded that the use of AEDs has had a bearing on the results of this study, as ethosuximide and valproic acid have been associated with neurocognitive side effects . Nonetheless, because current guidelines prescribe the use of these AEDs, the results in this study reflect children with CAE at this point in time.…”

Section: Discussionmentioning

confidence: 83%

“…Furthermore, it cannot be excluded that the use of AEDs has had a bearing on the results of this study, as ethosuximide and valproic acid have been associated with neurocognitive side effects. 9,50 Nonetheless, because current guidelines prescribe the use of these AEDs, the results in this study reflect children with CAE at this point in time. Furthermore, no relation was found between the duration of AED use and the frontal myelin-water content in this study, indicating that our results are not driven by medication use.…”

Section: Study Considerationsmentioning

confidence: 81%

Lower myelin‐water content of the frontal lobe in childhood absence epilepsy

et al. 2019

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Objective The frontal lobe in childhood absence epilepsy (CAE) might be affected due to the suggested involvement of the frontal lobe during absence seizures and reports on attentional deficits. Previously, subtle white matter abnormalities have been reported in CAE. However, the impact of one of the most characteristic components of the white matter, the myelin content, remains underdetermined. Therefore, this study investigated whether the myelin content in frontal areas is adversely affected in CAE compared to controls. Methods Seventeen children with childhood absence epilepsy (mean age ± standard deviation [SD], 9.2 ± 2.1 years) and 15 age‐ and sex‐matched controls (mean age ± SD, 9.8 ± 1.8 years) underwent neuropsychological assessment and a magnetic resonance imaging (MRI) examination. T2 relaxometry scans were used to distinguish myelin‐water from tissue water and to determine the myelin‐water fraction (MWF) in the frontal, temporal, parietal, occipital, and insular lobes. A linear regression model including age and sex as covariates was used to investigate group differences. Furthermore, the relationship of MWF with cognitive performance and epilepsy characteristics was determined. Results The frontal lobe revealed a significantly lower myelin‐water content in children with CAE compared to controls over the developmental age range of 6‐12 years (5.7 ± 1.0% vs 6.6 ± 1.1%, P = 0.02). This association was not found for any of the other four lobes (P > 0.10). No significant relation was found between myelin‐water content and cognitive performance or epilepsy characteristics. Significance The lower frontal myelin‐water content of children with CAE in comparison with healthy controls probably reflects an altered neurodevelopmental aspect in CAE, of which the underlying mechanisms still need to be unraveled.

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“…54 A cross-sectional study investigating the cognitive profile of ethosuximide suggests the attentional dysfunction comparable to those of other AEDs. 55 Oxcarbazepine, carbamazepine, tiagabine, vigabatrin, phenobarbital, and phenytoin should be avoided. Focal interictal paroxysmal abnormalities are not uncommon in the EEG of patients with typical absence; however, the response to valproic acid and ethosuximide continue to be excellent.…”

Section: Casementioning

confidence: 99%

Medical Management in Focal versus Generalized Epilepsy

Sannagowdara

Khan

2021

Journal of Pediatric Epilepsy

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About 70% of children with new-onset epilepsy have the potential to become seizure-free on antiepileptic drug (AED) monotherapy with appropriately selected first-line medication. In ideal world, physician is expected to achieve best possible seizure control without impacting the quality of life. There is rapid increase in number of AEDs available over last couple of decades. Although not necessarily all of them are superior to old generation drugs in terms of seizure control, certainly there is change in landscape from perspective of tolerability and side-effect profile. Physicians must therefore be familiar with safety, tolerability, therapeutic effects, synergistic combinations as well as AEDs to avoid in specific circumstances. The article attempts to give general overview of available AEDs under broad umbrella of effectiveness against focal and generalized seizures as well as drugs with “broad spectrum.” The emergence of newer AEDs with broad spectrum and favorable side-effect profile is welcome. However, the future lies in better understanding of underlying diverse pathophysiology of clinical symptom “epilepsy” and developing new compounds acting on molecular targets as well as individualizing therapy. Technological advances in molecular genetics research are bringing precision medicine to the fore.

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The Cognitive Profile of Ethosuximide in Children

Cited by 18 publications

References 14 publications

Towards a Better Understanding of Cognitive Deficits in Absence Epilepsy: a Systematic Review and Meta-Analysis

Towards a Better Understanding of Cognitive Deficits in Absence Epilepsy: a Systematic Review and Meta-Analysis

Lower myelin‐water content of the frontal lobe in childhood absence epilepsy

Medical Management in Focal versus Generalized Epilepsy

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