Effects on executive functions of antiepileptic monotherapy in pediatric age.

Francesca Felicia Operto, Grazia Maria Giovanna Pastorino, Roberta Mazza, Marco Carotenuto, Michele Roccella, Rosa Marotta, Carlo di Bonaventura, Alberto Verrotti

Journal: Epilepsy & behavior : E&B 2020;102():106648

PMID: 31715510

Full Text on Elsevier Science View on PubMed

Abstract

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.

Address: Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy. Electronic address: [email protected].; Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Università degli Studi della Campania L. Vanvitelli, Napoli, Italy.; Child and Adolescent Neuropsychiatry, Department of Basic Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy.; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Università degli Studi della Campania L. Vanvitelli, Napoli, Italy.; Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Palermo, Italy.; Department of Health Sciences, University Magna Graecia, Catanzaro, Italy.; Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy.; Department of Pediatrics, University of L'Aquila, L'Aquila, Italy.

DOI: 10.1016/j.yebeh.2019.106648

Link outs

Free resources

Medical:

https://medlineplus.gov/epilepsy.html

Subscription / membership required

Full Text Sources:

MeSH Terms: Adolescent, Age Factors, Anticonvulsants, Carbamazepine, Child, Epilepsy, Executive Function, Female, Humans, Levetiracetam, Male, Oxcarbazepine, Quality of Life, Retrospective Studies