The literature on cognitive and behavioral impairments in children treated for epilepsy with various antiepileptic drugs (AEDs) is reviewed from the Children’s Hospital, Boston, MA. Although the prevalence of cognitive and behavioral disorders is higher among children with epilepsy than in their nonepileptic peers, the role of AEDs is generally overrated by statistical analysis of results of group studies. More recent research suggests that the majority of children taking AEDs in therapeutic levels are not at risk, and the minority who are affected can be recognized clinically. Additional factors responsible for mental impairment in epilepsy include heredity, brain damage, seizures, and psychosocial (Lennox WG, 1942). Most reviews concern conventional AEDs. Among add-on trials and case-reports of newer AEDs, gabapentin and vigabatrin (VGB) may cause hyperactivity, aggressive outbursts, and oppositional behavior in learning disabled children, VGB has induced psychosis and depression, and rarely, valproate has caused a reversible pseudoatrophy of the brain associated with a drop in the IQ scores. [1]
COMMENT. The reported prevalence of cognitive and behavioral impairments attributed to antiepileptic treatment of childhood epilepsy has been overrated. In the minority affected, deficits may be recognized clinically and can often be explained by polytherapy and/or excessive drug levels. A concomitant ADHD can also underly impairments of attention and behavior, unrelated to the AEDs. Controlled studies are needed to identify risk factors for AED-induced cognitive and behavioral disorders in children treated for epilepsy.
Bourgeois BFD, the author of the above review, also summarizes the indications, pharmacokinetics, and side effects of the newer antiepileptic drugs, felbamate, gabapentin, lamotrigine, tiagabine, vigabatrin, and oxcarbazepine. [2]
Clobazam Efficacy. Clobazam (CLB) has equivalent efficacy to carbamazepine and phenytoin as monotherapy for childhood epilepsy, according to a report from a Canadian Study Group for Childhood Epilepsy [3]. The authors conclude that CLB should be considered a first line monotherapy for partial and selected generalized childhood epilepsies.
Lamotrigine Monotherapy for Partial Seizures. A controlled multicenter trial of lamotrigine (LTG) monotherapy compared to valproate (VPA) for partial seizures in adults found 56% successfully maintained on LTG compared to 20% on VPA. [4]