Antiepileptic Drugs Affect Cognition in Children. (Monitor for Behavior Problems)
Kirn, Timothy F., Clinical Psychiatry News
SEATTLE -- Some may be better than others, but probably every antiepileptic drug affects cognitive functioning in children, even the newer medications that have been approved in the last few years, Dr. Eileen Vining said at the annual meeting of the American Epilepsy Society.
There is a conspicuous lack of good information on how various drugs may or may not affect cognitive functioning in children, said Dr. Vining of the Pediatric Epilepsy Center at Johns Hopkins University Baltimore.
Moreover, what information does exist is like "pea soup"--thick and unclear, she said. Some findings have been contradictory, and most of the studies have been done in adults and so might not apply particularly in the developing brain.
Still, it is reasonable to assume that all antiepilepsy drugs have some cognitive impact since they are drugs used precisely because they do act on the CNS.
Given the absence of cognitive-impact information, the initial choice of a medication for an individual patient cannot be based on a cognitive profile. Seizure control and general tolerability must be the foremost criteria. The physician should monitor patients for school and behavioral problems, as there may be some differences between particular drugs, Dr. Vining said.
Epilepsy itself is frequently associated with intelligence, learning, social, and behavioral problems, so potentially it is important not to exacerbate any problems a child might have.
Two principles are clear when considering the cognitive effects of the drugs, she said. Single-drug therapy is better than polypharmacy, and the lower the dose the better. Strictly speaking, the evidence to back up those principles is not what one might consider "class A," she said. But, common sense would argue that this is true, and the general thrust of the research appears to bear it out.
Dr. Vining made the following comments about what is known about neurocognitive functioning and some available epilepsy drugs:
* Phenobarbital. This is one of the few drugs for which there is information specifically about children, Dr. Vining said. It has been shown to have a detrimental impact on memory and general comprehension, and those effects are related to dose and treatment duration.
In one study, it was shown to hurt reading and learning in the long term. …