A test battery to assess neuropsychological and behavioral changes associated with anticonvulsant, particularly valproate, therapy in children is proposed from the Departments of Pediatrics (Neurology), and Clinical Health and Psychology, University of Florida, Gainesville, FL. This includes 1) intellectual functioning (WISC-III, WPPSI-R), 2) verbal memory, sentence recall, story recall, and verbal learning (Wide Range Assessment of Memory and Learning-WRAML, 3) nonverbal memory, picture memory and visual learning-WRAML, 4) attention, digit span, continuous performance task-Paced Auditory Serial Addition Task-PASAT, 5) motor speed-finger tapping test, verbal fluency-Controlled Oral Word Association, and 6) problem behaviors-Child Behavior Check List. These tests were found to be sensitive to AED-induced cognitive changes, and some tests are repeatable to allow for frequent monitoring. [1]

COMMENT. The authors comment that the cognitive effects of valproate reported in normal adult volunteers and adults with epilepsy cannot reliably be applied to children. There is a relative paucity of well-controlled studies assessing memory and attentional differences in pediatric epilepsy patients treated with valproate monotherapy. Reports that cognitively impaired children on valproate therapy improve with L-acetylcarnitine supplements requires further study.

In one study involving children with epilepsy previously untreated, significant positive correlations were found between serum levels of valproate and the sum of 5 memory tests at 1 month and at 6 months after starting valproate monotherapy. Phenytoin had no adverse effects, whereas carbamazepine serum levels showed a negative correlation with memory and reading scores [2]. For reviews of Cognitive Effects of Antiepileptic Drugs, see Progress in Pediatric Neurology II, Chicago, PNB Publ, 1994.