Epilepsy, antiepileptic drugs (AEDs) and cognition

People with epilepsy are at increased risk of cognitive deficits as a result of various factors: the effect of seizures themselves, psychosocial factors and adverse effects of AEDs. It is crucial that, following early diagnosis of the correct epileptic syndrome, patients are treated with the appropriate drugs, as incorrect AEDs can exacerbate symptoms. By discussing various epileptic syndromes and performing a broad review of the available evidence, it is possible to make recommendations concerning prescription of AEDs with respect to cognition. An interesting advance in this area is the increasing use of AEDs such as valproate (in some countries divalproex is indicated), carbamazepine or lamotrigine (lamotrigine has been filed for approval in this indication) for bipolar disorders. Children and the elderly are especially vulnerable to adverse effects on cognition. This review highlights advantages of valproate in these populations; it is well tolerated and produces few cognitive side effects.