The Effect of Antiepileptic Drugs on Cognition: Patient Perceived Cognitive Problems of Topiramate versus Levetiracetam in Clinical Practice.
BACKGROUND
Neurocognitive complaints may interfere with long-term antiepileptic drug (AED) treatment and are an important issue in clinical practice. Most data about drug-induced cognitive problems are derived from highly controlled short-term clinical trials. We analyzed such cognitive complaints for the two most commonly used AEDs in a clinical setting using patient perceived problems as primary outcome measure.


METHODS
All patients of the epilepsy center Kempenhaeghe that received topiramate (TPM) or levetiracetam (LEV) from the introduction to mid 2004 were analyzed using a medical information system, an automated medical file. Patients were analyzed after 6, 12, and 18 months of treatment.


RESULTS
Four hundred and two patients used either TPM (n = 260) or LEV (n = 142); 18 months retention showed a statistically significant difference, revealing 15% more patients that continued LEV compared to TPM: 18 months retention 46% for TPM and 61% for LEV [F (1.400) = 3.313, p = 0.043]. Neurocognitive complaints accounted for a significant number of drug discontinuations and especially the high frequency of neurocognitive complaints in the first period of TPM treatment appeared to be significant different from LEV [F(2,547) = 3.192, p = 0.042]. In the remaining patients, the difference in neurocognitive complaints was not statistically significant.


CONCLUSIONS
cognitive complaints are common in TPM treatment and frequently lead to drug withdrawal. The impact of LEV on cognitive function is only mild. This leads to a much higher (15%) drug discontinuation rate for TPM compared to LEV.
Bootsma
Hans-Peter R
HP
Department of Neurology of the Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands. BootsmaHP@kempenhaeghe.nl
Aldenkamp
Albert P
AP
Diepman
Leonie
L
Hulsman
Jacques
J
Lambrechts
Danielle
D
Leenen
Loes
L
Majoie
Marian
M
Schellekens
Ad
A
de Krom
Marc
M
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001294:Attitude to Health; D002648:Child; D003072:Cognition Disorders / Q000139:chemically induced* / Q000523:psychology; D004363:Drug Utilization / Q000706:statistics & numerical data; D004827:Epilepsy / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D010352:Patient Dropouts; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077236:Topiramate
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose; D000077287:Levetiracetam; D010889:Piracetam