Abstracts

Many AEDs result in improved seizure control and minimal side effects. Although subtle cognitive effects are detectable in a small number of children, they can be masked when averaged among group data. This study was conducted to examine neurocognitive functioning in a diverse clinic population of children prior to and following a change in AED, looking at individual effects on cognition.
Subjects were 22 children under the age of 16 for whom a change in medication had been prescribed for clinical purposes. Eight AEDs were used, including topiramate (n=6), gabapentin (n=3), levetricacetam (n=2), zonisamide (n=2), phenobarbital (n=1), carbamazapine (n=1), lamotrigine (n=1), and valproic acid (n=1). Patients were tested prior to and following medication change. For children between the developmental ages of 6 and 16, instruments sensitive to domains of attention, language, memory, and fine motor skill were used. Parents of children under the age of 6 were administered a questionnaire to assess their child[apos]s level of adaptive functioning. Data were examined using a non-parametric sign test to examine frequency of changes in performance.
Eleven children were between the developmental ages of 6 and 16 and able to complete standardized tests. An aspect of attention as assessed on standard test measures improved following AED change (Trailmaking Test, Part B, p [lt] .05). Although statistically non-significant, a majority of participants experienced word retrieval difficulties following AED change (Boston Naming Test, P = .17) and were associated with difficulties in academic and social domains. By parent report, both positive and adverse changes in temperament and attention were noted in all participants following medication change. Although the test instruments used were not sensitive enough to capture these changes, parent reports were sufficiently consistent to support both that these changes were common and that more sensitive instruments should be used. There was generally no apparent relationship between improvement in seizure activity and changes in cognitive functioning or temperament.
Cognitive changes were detected in association with several medications. Most changes were relatively subtle and statistically non-significant when averaged among the group data. Findings were generally consistent with results from prior research. Nevertheless, the adverse effects on individual children[apos]s attention and language/retrieval are of concern. Vulnerability in these domains can place a child at risk for academic and psychosocial difficulties when not appropriately addressed. Use of a brief test protocol and/or questionnaire is suggested to routinely assess cognitive and behavioral functioning pre- and post-medication change in conjunction with formally assessing changes in overt seizure activity.
[Supported by: an Epilepsy Foundation Grant to Amy Morgan, Ph.D.]