Cognitive effect of antiseizure medications in medial temporal lobe epilepsy

Author:

Dusanter Cedric1ORCID,Houot Marion234,Mere Marie1ORCID,Denos Marisa5,Samson Séverine6,Herlin Bastien7,Navarro Vincent18910ORCID,Dupont Sophie15910ORCID

Affiliation:

1. Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies AP‐HP, Pitié‐Salpêtrière Hospital Paris France

2. Centre of Excellence of Neurodegenerative Disease (CoEN) AP‐HP, Pitié‐Salpêtrière Hospital Paris France

3. Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A) AP‐HP, Pitié‐Salpêtrière Hospital Paris France

4. Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM) Pitié‐Salpêtrière Hospital Paris France

5. Rehabilitation Unit AP‐HP, Pitié‐Salpêtrière Hospital Paris France

6. Univ. Lille, ULR 4072 – PSITEC – Psychologie: Interactions Temps Émotions Cognition Lille France

7. CEA Neurospin Unité Mixte de Recherche BAOBAB (Building Large Instruments for Neuroimaging: From Population Imaging to Ultra‐High Magnetic Fields) Paris France

8. Neurophysiology Unit AP‐HP, Pitié‐Salpêtrière Hospital Paris France

9. Université Paris Sorbonne Paris France

10. Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (ICM), UMPC‐UMR 7225 CNRS‐UMRS 975 Inserm Paris France

Abstract

AbstractBackground and purposeThe specific effects of antiseizure medications (ASMs) on cognition are a rich field of study, with many ongoing questions. The aim of this study was to evaluate these effects in a homogeneous group of patients with epilepsy to guide clinicians to choose the most appropriate medications.MethodsWe retrospectively identified 287 refractory patients with medial temporal lobe epilepsy associated with hippocampal sclerosis. Scores measuring general cognition (global, verbal and performance IQ), working memory, episodic memory, executive functions, and language abilities were correlated with ASM type, number, dosage and generation (old vs. new). We also assessed non‐modifiable factors affecting cognition, such as demographics and epilepsy‐related factors.ResultsKey parameters were total number of ASMs and specific medications, especially topiramate (TPM) and sodium valproate (VPA). Four cognitive profiles of the ASMs were identified: (i) drugs with an overall detrimental effect on cognition (TPM, VPA); (ii) drugs with negative effects on specific areas: verbal memory and language skills (carbamazepine), and language functions (zonisamide); (iii) drugs affecting a single function in a specific and limited area: visual denomination (oxcarbazepine, lacosamide); and (iv) drugs without documented cognitive side effects. Non‐modifiable factors such as age at testing, age at seizure onset, and history of febrile seizures also influenced cognition and were notably influenced by total number of ASMs.ConclusionWe conclude that ASMs significantly impact cognition. Key parameters were total number of ASMs and specific medications, especially TPM and VPA. These results should lead to a reduction in the number of drugs received and the avoidance of medications with unfavorable cognitive profiles.

Publisher

Wiley

Subject

Neurology (clinical),Neurology

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