Withdrawing antiepileptic drugs in seizure-free patients: what are the cognitive benefits?  

Oleh:

Perucca, Emilio

Jenis: Article from Bulletin/Magazine - ilmiah internasional
Dalam koleksi: Medical Progress vol. 34 no. 05 (May 2007), page 213.

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Perpustakaan FK Nomor Panggil: M36.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Original article: Hessen E, et aLI",fluence qfll1ajor antiepi!eptic drugs on attentiol), reactiol) time and speed of information processing: results from a randomized, double-blind, placebo-controlled withdraw~lstudy ofseiz"te4ree.epilepsy patients receiving 1I10notherapy.~pilepsia 2006;41:2038-2045. BACKGROUND: To evaluate the effect ofantiepileptitdrugs (AI::D) withdrawal on attention, reaction tif)1eand speed ofinforrnationprocessing, DESIGN: This randomized, double-blind,placebo. controlled study, conducted in Norway,asses$ed139 adUlt patients witfjepHepsy (aged 18.66 years) who hadbeel) seizure-free for at least 2 years. All participants were on AED monotherapy, most with carbannazepine (64%) orvalproate (190/0). A~Dtreatnnent was discontinued over a period of 14 weeks (switch to placebo) in 64patients, whereas AED treatnnent was continued in75 patients. Neuropsychological asses$nnents were conducted at baseline and at 7 rnonths aftertheintervention (treatnnentdiscQntinUation or no discontinuation) using the California Computerized Assessment Package (CaICAP@; Miller EN;Lo$Angeles, CA,t,)SA).To adjust for multiple cOrnpatisons, the signifitancefevel ofind~pendentt-tests was set at p <0.01. RESULTS:Withregard to the mean reaction time (RD, AED withdrawal sign:!ficantlyimProved results On a choiceRTtask and on a task evaluating rapid language discrimination, cOrnpared with AED continuation (difference between baseline and 7nnonths~~24 ms VS 4 rns, p <0.001 for choice RTi ~17 ms VS 7ms,p80.003 for langUagedisctlrnination). Irnprovennents after AED withdrawal were nearly significant (p-values in the range 0.013-0.067) for three other subtests assessing connplex cognitive processing and nOnsignificant for alfsiJbtests evaluating simpler forms of attention and RT. With regard to true-positive responses, near-significant(P$O.05)irnprovernents were achievedJorform discrimination and langUage discrinninatioO/rhere were no significant differences between the two groups in terms of false-positive responses. patients receiVing carbamazepipe or. valproatemonotherapy had results that were cornparable to those observed.for the whole study group, but valproate withdrawal did not result in significan(+rnprovennents over valproate coPtinuationinthe choice RT and language discrilTiinalipnsUbtests.: CONCLUSION: Withdrawal of AED monotherapy in patients with seizure-free epilepsy can have a pO$itive impact ontbeperformance of tasks that require divided attentibn of fast inforrnation processing.

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