The Effect of Antiepileptic Therapy on the Development of Cognitive Functions in Children with Epilepsy: Introduction To The Problem

Author Name(s): Rimma Gamirova, Tatyana Akhutina, Elena Gorobets,*Ruzalina Shaykhutdinova
Author Email: elena_gorobets@mail.ru

Abstract

Epilepsy is a chronic disease, and the control of seizures requires a long-term – and sometimes lifelong – treatment with antiepileptic drugs (AEDs). The most important goal of epilepsy pharmacotherapy is the maximum effectiveness of AEDs, which is determined by the ability to completely stop epileptic seizures with a minimum of side effects. The most frequent undesirable drug reactions recorded during antiepileptic therapy are their sedative effect, memory impairment and attention problems. In this regard, it is especially important to assess the impact of AEDs on cognitive functions during the long-term treatment. The article is devoted to the problem of studying the development of speech and other cognitive functions in children with different forms of epilepsy against the background of antiepileptic therapy using a set of methods for studying brain processes. The number of children with speech disorders and the delay in the development of cognitive functions in the world is steadily increasing. A special group of children with disorders of this kind are children with epilepsy, since they are contraindicated with drugs traditionally used by neurologists in the therapy of speech disorders. The influence of antiepileptic therapy on the development of speech functions at the moment has not been studied in detail. The linguistic component of psychometric instruments, including the evaluation of speech development, cognitive functions, especially in children and adolescents with epilepsy in Russia currently needs serious scientific development and experimental justification with a focus on European samples with the aim of optimizing joint international research.

Introduction

The complexity of assessing the effect of AEDs on cognitive functions in persons with epilepsy is that the state of cognitive functions may also depend on several factors, among which the side effects of AEDs are only one of many assumed causes. In connection with this, the most difficult problem is the use of an adequate methodology that makes it possible to isolate and evaluate the side effect of AEDs. One way to compare the effect of AEDs on cognitive functions may be to test patients with newly diagnosed epilepsy before and during treatment at optimal therapeutic doses in a randomized, double-blind study [Perucca 2007, 3: 194].

The effect on speech is not usually emphasized in the list of side effects of antiepileptic drugs. For the first time, the negative effect on speech was first mentioned in the study of undesirable drug reactions of topiramate. In patients who received topiramate, amnestic aphasia and difficulties in word selection were reported [Ojemann 2001, 2: 581]. It should be noted that mainly adult patients were included in the studies, while there are practically no such publications for children.

Neuropsychological and neurolinguistic diagnostics of children with epilepsy is also specific. Existing methods for assessing the development of higher mental functions take a long time and require additional skills, whereas in the case of epilepsy, therapy should be prescribed immediately and the neurologist has to make the fastest diagnosis.

Conclusion

In comparative evaluation of the negative impact of different AEDs on the cognitive functions in children and adolescents with epilepsy, the most promising are the studies which include the use of specially developed neuro psychologically and linguistically validated tests to assess cognitive functions and speech status for children and adolescents suffering from idiopathic forms of epilepsy ranked for different ages before treatment and further in dynamics during the AEDs therapy.

The linguistic component of psychometric instruments, including the evaluation of speech development, cognitive functions, especially in children and adolescents with epilepsy – one of the chronic, often disabling diseases, in Russia currently needs serious scientific development and experimental justification with a focus on European samples with the aim of optimizing joint international research.

None of the existing methods of cognitive functions assessment gives a possibility of express evaluation that could be used in clinical practice in a “quick response” situation (in the event of epileptic seizures, therapy should be administered immediately, and the cognitive functions of patients need to be evaluated very quickly).

Evaluation of the isolated effect of AEDs impact on cognitive functions is probably most acceptable in children with idiopathic forms of epilepsy, in which, unlike age-dependent epileptic encephalopathies, the effect of epilepsy itself on cognitive functions is minimal.

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