Effects on executive functions of antiepileptic monotherapy in pediatric age
Francesca Felicia Operto1, Grazia Maria Giovanna Pastorino2, Roberta Mazza3
1Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
Insights
Levetiracetam improved executive functions in pediatric epilepsy patients, while carbamazepine worsened them. Further research is needed to confirm these findings on antiseizure medications and cognitive outcomes.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Pharmacology
Background:
- Cognitive and executive functions are crucial for quality of life and academic success in children and adolescents.
- Epilepsy and its treatments, including antiseizure drugs, can negatively impact cognitive and executive functioning.
- Understanding the specific effects of different antiseizure medications on executive functions in pediatric epilepsy is essential.
Purpose of the Study:
- To assess the longitudinal changes in executive functioning in pediatric epilepsy patients undergoing monotherapy with a single antiseizure medication.
- To compare the effects of different antiseizure medications (levetiracetam, valproic acid, ethosuximide, oxcarbazepine, carbamazepine) on executive functions.
Main Methods:
- An observational retrospective study involving 172 children and adolescents (6-18 years) with newly diagnosed epilepsy.
- Executive functioning was assessed using the EpiTrack Junior test at baseline and at 3, 6, and 9-month follow-ups.
- Patients were treated with a single antiseizure medication: levetiracetam, valproic acid, ethosuximide, oxcarbazepine, or carbamazepine.
Main Results:
- Executive functioning scores deteriorated at 9 months for patients on valproic acid, ethosuximide, and carbamazepine, with a statistically significant decline observed with carbamazepine.
- Executive functioning scores improved at 9 months for patients on levetiracetam and oxcarbazepine, with a statistically significant improvement noted for levetiracetam.
- Levetiracetam was associated with slight improvements, while carbamazepine was linked to deteriorations in cognitive functioning.
Conclusions:
- Levetiracetam demonstrated a positive impact on executive functioning in pediatric epilepsy patients.
- Carbamazepine was associated with a negative impact on cognitive functioning in this population.
- Further rigorous investigation, including double-blinded, placebo-controlled trials, is warranted to validate these findings.
Objectives:
Cognitive abilities and executive functions in children and adolescents are important indicators of quality of life as well as academic and social achievements. Cognitive and executive functioning are often impaired in patients with epilepsy and can be exacerbated by seizures and antiseizure drugs. The aim of our observational retrospective study was to assess executive functioning in patients with pediatric epilepsy, currently taking a single antiseizure medication.
Materials And Methods:
Records of 172 children and adolescents aged between 6 and 18 years (mean age = 12 ± 3.4 years) with newly diagnosed epilepsy who had not yet commenced an antiepileptic treatment were included in the study. Longitudinal changes in executive functioning were assessed using the EpiTrack Junior test at baseline, before the introduction of antiepileptic monotherapy, and at 3-month, 6-month, and 9-month follow-up visits. All patients commenced a single antiepileptic treatment (levetiracetam n = 54; valproic acid n = 52; ethosuximide n = 20; oxcarbazepine n = 22; carbamazepine n = 24). Age, sex, seizure types, and seizure baseline frequency were also recorded.
Results:
Relative to baseline, Epitrack Junior mean scores deteriorated at the 9-month follow-up visit for patients taking valproic acid, ethosuximide, and carbamazepine, but this was only statistically significant for patients taking carbamazepine. In contrast, mean scores improved for subjects taking levetiracetam and oxcarbazepine at the 9-month follow-up visit relative to baseline, but this was only statistically significant for patients taking levetiracetam.
Conclusions:
Levetiracetam was the only antiseizure medication that led to slight improvements in executive functioning; whereas carbamazepine led to deteriorations in cognitive functioning. Further research using double-blinded, placebo-controlled trials are needed to confirm these results.
More Related Videos
10:02Event Related Potentials ERPs and other EEG Based Methods for Extracting Biomarkers of Brain Dysfunction: Examples from Pediatric Attention Deficit/Hyperactivity Disorder ADHD
Published on: March 12, 2020
07:01Electrophoretic Delivery of γ-aminobutyric Acid GABA into Epileptic Focus Prevents Seizures in Mice
Published on: May 16, 2019
Related Concept Videos
01:20Antiepileptic Drugs: Modulators of Neurotransmitter Release Mediated by SV2A Protein
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:20Antiepileptic Drugs: Potassium Channel Activators
Ezogabine has gained approval as an adjunctive treatment...
01:14Antiepileptic Drugs: Glutamate Antagonists
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion