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Loring and Meador review the cognitive and behavioral side effects of antiepileptic drugs (AED) in children, and suggest that the still inconclusive and contradictory findings reflect study design limitations. Because pediatric AED effects occur against the backdrop of brain maturation, long-term longitudinal, randomized studies will be needed to evaluate AED effects on cognitive development.
see page 872
Cognitive consequences of antiepilepsy medications in children
Commentary by Bruce Hermann, PhD, and Raj Sheth, MD
Epilepsy in childhood is a common condition fraught with both short- and long-term implications. Parents, teachers, physicians, and other professionals harbor many concerns for the long-term quality of life of affected children. Early problems in behavior, cognition, and academic achievement can have long-lasting consequences; therefore, deriving a clear understanding of the causes of these neurobehavioral problems in children with epilepsy is important. While there is little doubt that efficacy of treatment is a primary concern, these other concerns can be of equal weight.
Cognitive problems and academic underachievement in particular are often examined in relation to the direct consequences of the underlying cause of the epilepsy; the type, frequency, and severity of seizures; and other clinical markers of the disorder. At the same time, there remains considerable concern regarding the possibility that medications may impede rather than foster achievement and, directly and indirectly, worsen quality of life. The potential adverse effects of antiepilepsy medications on cognition has been addressed, but the literature pertaining to their effects on cognition is limited, and attempts to isolate the individual contribution of medications vs other factors are still less common.
Loring and Meador critically review the literature concerning the impact of antiepilepsy medications on cognition in children and enumerate and detail the nature and magnitude of the many methodologic and conceptual problems inherent in the published research. While acknowledging that this is a very difficult area of inquiry, they demonstrate that the quality of the available evidence is even poorer than we might have expected. When one considers that the trajectory of a person’s life may be affected greatly by even small influences early on, this state of affairs is unacceptable.
It is imperative that a better understanding of the effects of antiepilepsy medications on cognition be achieved. In addition, a better understanding of the effects of these medications on other areas of function—some related to cognition, others not—is perhaps just as important. For instance, the impact on bone mineralization, weight change, sleep, and hormonal function remain to be definitively clarified. To take but one of these as an example: would prescribers of antiepileptic medications for children develop a new calculus for preferred drugs to be used long term, if they knew that particular medications predispose the adult to osteopenia or osteoporosis—and fractures? Finding the answers to these questions, in a rigorous fashion as suggested by Loring and Meador, will improve the quality of care as well as the quality of life of children with epilepsy, the adults they will become, and their families.
see page 872
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