Abstracts

RATIONALE:Antiepileptic drugs (AEDs) can affect cognitive performance. Few studies were published concerning topiramate (TPM) use. Moreover, most of them included small series of patients and limited cognitive examinations. The aim of the present study is to evaluate whether the use of topiramate during several months in polypharmacy, affects neuropsychological perfrmance of patients with intractable epilepsy. METHODS: 44 patients were assessed with a cognitive battery prior to the initiation of therapy with TPM and 6 months after stabilizing the dosage. Cognitive measures evaluated verbal and nonverbal memory, executive functions, verbal fluency, language, visuomotor processing, psychomotor functions. Cognitive study was parallel to clinical "add-on" studies TOP-POR1 and TOPMAT EPAJ111. A quality of life (QOLIE-31) was also done. RESULTS:Statistical analysis did not show disturbance in motor functions, sustained attention and in logic and visual memory tests of WMS. It revealed decline in semantic verbal fluency, verbal learning, working memory and visuomotor processing. Concerning dosage and number of other AEDs, decline was greater in patients with TPM dosages above 400 mg and in those taking 2 or less AEDs. No differences were found in quality of life study. There was an improvement in number of seizures. CONCLUSIONS: As other AEDs, TPM use in patients with intractable epilepsy and polypharmacy may be associated with cognitive effects. It is more relevant when patients take higher dosages. Disturbances are related to frontal lobe functions. They can be related to an effective action of TPM on ?-aminobutiric acid (GABA) neurotransmitter system which has inhibitory properties in forebrain structures.