Cognitive and Behavioral Effects of Antiepileptic Drugs

The burden of epilepsy extends beyond the physical seizure activity to encumber multiple aspects of an individual's life: independence, employment, education, social confidence, self-esteem, relationships, finances, medical management, stability, future planning, pregnancy, cognitive function, and mental health form only a partial list. Seizure freedom through successful treatment can reclaim much in the individual's life that had previously been controlled by either the occurrence or risk of seizures. Seizure freedom, however, is not achievable in all patients, nor is it without risk of cognitive or behavioral impairment or neurotoxicity due to adverse effects of AEDs. To optimize seizure control, an AED must be selected from among those most efficacious for the patient's epilepsy type. To maximize cognitive and behavioral function, the AED with the best cognitive and behavioral profile and the lowest neurotoxicity is typically the best choice. AEDs traditionally selected for first-line treatment, while efficacious for many patients, have rather unfavorable cognitive, behavioral, and neurotoxicity profiles. Clinical trials of newer AEDs demonstrate that these agents provide the same efficacy with minimal cognitive and behavioral impairment and neurotoxicity. For individuals who do not achieve a seizure-free status, HRQOL studies show that improved cognitive and behavioral function and reduced neurotoxicity contribute to an improved QOL.