Abstracts

Rationale: Antiepileptic drugs can have positive and negative psychotropic effects. The risk profiles of individual drugs, however, must be concluded from studies with very heterogeneous study designs, control conditions and cognitive measures. This study aimed at the cross-sectional head-to-head comparison of the cognitive effects of common AEDs given in mono- or polytherapy, employing one screening test. Results: Greater drug load as a trend correlated with lower education, earlier onset and longer duration of epilepsy, and higher seizure frequency (all rs < 0.2). Being off drug, 39% of the patients were impaired. Compared to this, the odds ratios for being impaired increased from 1.4 with monotherapy to 12.8 with 5 drugs in polytherapy. Following odds ratios, the individual AEDs in mono- and polytherapies could be ranked and grouped into three classes. Monotherapy: odds ratios < 1 (LCM, LTG, LEV, PGB, CLB), 1-2 (PB, OXC, VPA) > 2 (CBZ, TPM, PHT, ZNS, GBP). Polytherapy: odds ratios < 3 (PER,LCM,LTG,LEV), 3-4 (OXC,CBZ, PGB,RTG,PB, VPA,ESL), and >4 (ZNS,GBP,CLB,PHT,TPM). Conclusions: The study demonstrates that the known cognitive side effects of common AED can well be modelled using a short screening of executive functions (EpiTrack). The results help with drug choice and show under which conditions screening of cognition can help to stratify AED treatment beyond seizure control. The data may furthermore be used as patient norms for patients with different drug loads and treatments. Funding: there was no funding for this work