Withdrawal of antiepileptic medication in children–effects on cognitive function

Abstract

We present 100 children diagnosed with epilepsy who were seizure-free for more than 1 year and still on monotherapy of antiepileptic drugs (AEDs). We matched each child with a healthy classmate and performed neuropsychological testing and EEG before and after complete withdrawal of the AEDs. The withdrawal phase lasted 3 months, but the dose decrease was individualized for each patient. Three to 4 months after complete withdrawal of the drug all patients were reassessed. Patients with seizure relapse are excluded from the study. Seventeen patients are regarded as dropout, 11 because of seizure relapse and six because of protocol violation. The remaining 83 patients were treated with carbamazepine (n = 56), valproic acid (n = 17), or phenytoin (n = 10). Serum concentrations of the AEDs were measured using peak plasma levels that were taken immediately before or after psychological testing. We used neuropsychological tests to assess psychomotor function and "central" cognitive processing such as information processing or memory function. We found significant improvement attributable to drug withdrawal on only one of the cognitive tests, namely, psychomotor speed, suggesting that the impact of AED treatment on higher-order cognitive function is rather limited. In addition, we found group differences between the epilepsy group and the control group at baseline that persisted after drug withdrawal. Subsequent analysis showed some factors that may have contributed to these group differences. First, patients with a former diagnosis of absence seizures show lower scores both at baseline and after drug withdrawal. We may assume that the seizure propensity has not disappeared completely in these patients. Some evidence is found that phenytoin may have a different cognitive profile than carbamazepine, with more impairment on tests that measure motor and mental speed. Again, this impairment persists after drug withdrawal.

Antiepileptic Drugs, Learning, and Behavior in Childhood Epilepsy

“…This persistent higher daytime sleep tendency could not be attributed to treatment or to seizure activity. The results of a large multicenter study based on AED discontinuation in children were reported by Aldenkamp et al (55). One hundred children who had been seizurefree for at least 1 year on a single AED were matched with healthy classmates.…”

Staggered spondaic word test in epileptic patients

“…These studies reveal that the cognitive performance of epileptic children differs in comparison with control groups and it also differs between groups of epileptic children when different crisis types are studied: partial or generalized crises. [5][6][7] In view of the fact that cognitive functions involve attention and memory and that central auditory processing also involves attention and memory, we suspected that there could be performance differences in tests assessing CAP in epileptic patients with partial or generalized crises.…”

Epileptic syndromes, cognitive assessment and school placement: a study of 251 children

“…For instance, poor academic achievement is widely reported in children with epilepsy, although many of these children have normal intelligence and stable intellectual ability (Bourgeois et al 1983, Seidenberg et al 1987. The influence of antiepileptic drugs (AEDs) on cognitive tasks has been discussed and is a topic of great interest in schoolchildren with epilepsy (Trimble 1990, Aldenkamp et al 1993.…”