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abilities, executive functions and ‘substantial’ weight gain. Some Nevertheless, researchers have
social competences.6 other AEDs, including phenytoin only just begun to understand the
• Juvenile myoclonic epilepsy and carbamazepine, increase lev- basis of cognitive deficits charac-
(JME) seems to arise in the fronto- els of homocysteine. Indeed, epi- teristic of epilepsy and their evo-
thalamic network. Patients with demiological studies suggest that lution over the patient’s lifetime.
JME or frontal lobe epilepsy typi- hypertension, ischaemic heart dis- For example, modern MRI scans
cally show impaired executive ease, heart failure, diabetes and visualise the microstructural and
functions. Some JME patients also cerebrovascular conditions are functional abnormalities poten-
exhibit impaired verbal and visual especially common among people tially associated with cognitive
memory, processing speed and lan- with epilepsy.5 impairment in unprecedented
guage.6 detail. However, a recent review
• Dysfunction of the Sylvian and Managing cognitive deficits noted that the use of microstruc-
Rolandic regions of the brain Unlike, for example, Alzheimer’s tural and functional MRI in
seems to produce benign epilepsy disease, pharmacologists have yet epilepsy ‘has been limited and
with centrotemporal spikes, which to devise a treatment that offsets focused mostly on adults’ and
is commonly associated with the cognitive impairment in called for longitudinal studies
impaired linguistic abilities. epilepsy. Nevertheless, proactive, from diagnosis.4 Hopefully, over
However, patients may also show multidisciplinary management can the next few years, a growing
mildly impaired attention and help. As a result, healthcare pro- body of evidence might help
executive functions.6 fessionals could consider screen- researchers develop much-
ing for cognitive adverse events, needed new ways to prevent,
Exacerbating factors especially when patients begin or detect and manage this common
Co-morbidities (including depres- switch an AED or report a possible comorbidity.
sion) and antiepileptic drugs cognitive side-effect. 3 Avoiding
(AEDs) can synergistically exacer- rapid titration, using the lowest Mark Greener is a Freelance Medical
bate the deficits arising from the effective AED dose and limiting Writer
neurological pathophysiology. overall exposure, choosing slow-
For example, bromide, benzo - release drugs to maintain relatively References
diazepines and phenobarbital steady blood levels, and selecting 1. Muzerengi S, Moor CC. What do we know
about depression in people with epilepsy?
impair cognition more frequently AEDs based on their cognitive Progress in Neurology and Psychiatry 2013;
than phenytoin, valproic acid or effects can help reduce the impact 17(2):20-4.
carbamazepine. Never theless, of treatment on cognition.3 2. Cardamone L, Salzberg M, O'Brien T, Jones
N. Antidepressant therapy in epilepsy: can
phenytoin, valproic acid and car- In addition, the multidiscipli- treating the comorbidities affect the underly-
bamazepine may still impair atten- nar y approach could manage ing disorder? Br J Pharmacol 2013;168:
tion and memor y. In general, behavioural problems, intervene in 1531-54.
3. Witt JA, Helmstaedter C. Monitoring the
newer AEDs produce fewer cogni- unsupportive family environments, cognitive effects of antiepileptic pharma-
tive effects, although topiramate and offer memory and cognitive cotherapy – approaching the individual
may impair attention, memor y training. For example, people with patient. Epilepsy Behav 2013;26:450-6.
4. Braakman HM, van der Kruijs SJ, Vaessen
and language. The cognitive epilepsy could benefit from com- MJ, et al. Microstructural and functional MRI
adverse events of AEDs usually puter-assisted working memory pro- studies of cognitive impairment in epilepsy.
abate after dose reduction or ces- grams, diaries and calendars, Epilepsia 2012;53:1690-9.
5. Hermann B, Seidenberg M, Sager M, et al.
sation.3 self-regulation exercises and prob- Growing old with epilepsy: the neglected issue
In addition, some AEDs can lem-solving techniques.6 Further - of cognitive and brain health in aging and
exacerbate vascular risk factors more, certain cardiovascular risk elder persons with chronic epilepsy. Epilepsia
2008;49:731-40.
that, potentially, promote vascu- factors – which can also contribute 6. Lin JJ, Mula M, Hermann BP. Uncovering
lar dementia and Alzheimer’s dis- to abnormal cognitive ageing and the neurobehavioural comorbidities of
ease. 8 In turn, dementia can dementia in the general population epilepsy over the lifespan. Lancet 2012;
380:1180-92.
further undermine cognitive – seem to be especially common in
7. Witt J-A, Helmstaedter C. Should cognition
functions that are already people with epilepsy.5 Therefore, be screened in new-onset epilepsies? A study
impaired by chronic epilepsy. For considering screening for and treat- in 247 untreated patients. J Neurol 2012;
example, valproic acid can lead to ing modifiable cardiovascular risk 259:1727-31.
8. Greener M. Clarifying the link between
hyperinsulinaemia, increase factors in people with epilepsy Alzheimer’s and vascular disease. Progress in
insulin resistance and promote seems prudent. Neurology and Psychiatry 2013;17(2):27-8.