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Cognitive and behavioral effects of new antiepileptic drugs in pediatric epilepsy
Romina Moavero1, Marta Elena Santarone2, Cinzia Galasso2
1Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Italy; Child Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Insights
Choosing the right antiepileptic drugs (AEDs) is vital for children with epilepsy and neurodevelopmental disorders. Lamotrigine and rufinamide show better cognitive and behavioral tolerance in pediatric epilepsy patients.
Area of Science:
- Pediatric Neurology
- Neurodevelopmental Disorders
- Pharmacology
Background:
- Neurodevelopmental comorbidities in pediatric epilepsy can be more disabling than seizures.
- Understanding the impact of antiepileptic drugs (AEDs) on cognition and behavior is crucial for effective treatment.
- Tailoring AED selection to specific neurodevelopmental disorders in children is essential.
Purpose of the Study:
- To review the cognitive and behavioral effects of new and emerging AEDs in pediatric epilepsy.
- To guide clinicians in selecting appropriate AEDs for children with epilepsy and co-occurring neurodevelopmental disorders.
- To highlight the importance of targeted AED use for improved patient outcomes.
Main Methods:
- Literature review of peer-reviewed publications from 2002 to October 2016 (PubMed).
- Inclusion of second and third-generation AEDs approved for pediatric use.
- Focus on AEDs with available data on cognitive and behavioral impact in children.
Main Results:
- Vigabatrin, lamotrigine, topiramate, levetiracetam, oxcarbazepine, zonisamide, rufinamide, lacosamide, eslicarbazepine, and perampanel were reviewed.
- Lamotrigine and rufinamide demonstrated the best cognitive and behavioral tolerability.
- These AEDs are recommended for children experiencing cognitive or attention difficulties.
Conclusions:
- Limited pediatric data exists for many AEDs, with most initially licensed for adults.
- Standardized cognitive and behavioral outcome measures are underutilized in pediatric AED clinical trials.
- Factors like polytherapy, drug mechanism, dose, and titration influence cognitive and behavioral side effects.
Background:
In pediatric epilepsy, neurodevelopmental comorbidities could be sometimes even more disabling than seizures themselves, therefore it is crucial for the clinicians to understand how to benefit these children, and to choose the proper antiepileptic drug for the treatment of epilepsy associated to a specific neurodevelopmental disorder. Aim of this paper is to discuss the potential impact on cognition and behavior of new and newest AEDs and to guide the choice of the clinicians for a targeted use in epilepsy associated with specific neurodevelopmental disorders.
Methods:
Information in this review is mainly based on peer-reviewed medical publications from 2002 until October 2016 (PubMed). We choose to include in our review only the AEDs of second and third generation approved for pediatric population.
Results:
Vigabatrin, lamotrigine, topiramate, levetiracetam, oxcarbazepine, zonisamide, rufinamide, lacosamide, eslicarbazepine, and perampanel have been included in this review. The most tolerated AEDs from a cognitive and behavioral point of view are lamotrigine and rufinamide, thus representing optimal drugs for children with cognitive and/or attention problems.
Discussion:
Most of the new AEDs are initially licensed for adult patients. Data on children are usually very limited, both in terms of efficacy and safety, and the use standardized cognitive and behavioral outcome measures are very limited in pediatric clinical trials.
Conclusion:
Several factors including polytherapy, administration of AEDs with the same mechanism of action and the dose and titration of the drug, should be considered as important in the development of cognitive and behavioral side effects.
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