COGNITIVE SIDE-EFFECTS OF ANTIEPILEPTIC DRUGS

All of the established antiepileptic drugs (AEDs) can produce cognitiv e side effects, which are increased with polypharmacy and with increas ing dosage and anticonvulsant blood levels. However, cognitive side ef fects are usually modest for AED monotherapy with anticonvulsant blood levels within the standard therapeutic ranges. Further, these effects are offset in part by reduced seizure activity. Controversy exists re garding possible differential cognitive effects of AEDs. A large porti on of the literature examining the comparative cognitive effects of AE Ds is limited by inadequate study designs. When these design flaws are considered, there is no convincing evidence of clinically significant differences in cognitive side effects of AEDs except possibly for bro mide, phenobarbital and benzodiazepines. The role of cognitive side ef fects should be kept in proper perspective when choosing AED therapy. The cognitive side effects of anticonvulsant drugs may be overt but ma ny times are rather subtle. It is important though to be able to recog nize these effects and to put them into perspective as to how they aff ect our patients.