Cognitive and behavioral effects of lamotrigine and carbamazepine monotherapy in patients with newly diagnosed or untreated partial epilepsy.
OBJECTIVE
In this prospective study, we compared the long-term cognitive and behavioral effects of lamotrigine (LTG) and carbamazepine (CBZ) in patients with newly diagnosed or untreated partial epilepsy.


METHODS
This was a multicenter, open-label, randomized study that compared monotherapy with LTG and CBZ in newly diagnosed or untreated patients with partial epilepsy. We employed an 8-week titration period and a 40-week maintenance period. Neuropsychological tests, Symptom Check List-90, and QOLIE-31 were assessed at baseline, 16 weeks, and 48 weeks after drug treatment. A group-by-time interaction was the primary outcome measure and was analyzed by use of the linear mixed model.


RESULTS
A total of 110 patients were eligible and 73 completed the 48-week study (LTG, n=39; CBZ, n=34). Among the cognitive tests, significant group-by-time interaction was identified only in phonemic fluency of Controlled Oral Word Association Task (p=0.0032) and Stroop Color-Word Interference (p=0.0283), with a significant better performance for LTG group. All other neuropsychological tests included did not show significant group-by-time interactions. Among the subscales of Symptom Check List-90, significant group-by-time interactions were identified in Obsessive-Compulsive (p=0.0005), Paranoid Ideation (p=0.0454), Global Severity Index (p=0.0194), and Positive Symptom Total (p=0.0197), with a significant improvement for CBZ group. QOLIE-31 did not show significant group-by-time interactions.


CONCLUSIONS
Our data suggest that epilepsy patients on LTG have better performance on phonemic fluency and the task of Stroop Color-Word Interference than do patients on CBZ, whereas patients on CBZ had more favorable behavioral effects on two subscales and two global scores of Symptom Check List-90 than did patients on LTG.
Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea. salee@amc.seoul.kr
Sang-Ahm
SA
Lee
Hyang-Woon
HW
Lee
Kyoung
K
Heo
Dong-Jin
DJ
Shin
Hong-Ki
HK
Song
Ok-Joon
OJ
Kim
Sun-Mi
SM
Lee
Seon-Ok
SO
Kim
Byung-In
BI
Lee
D000293:Adolescent; D000328:Adult; D001519:Behavior / Q000187:drug effects* / Q000502:physiology; D002220:Carbamazepine / Q000008:administration & dosage*; D003071:Cognition / Q000187:drug effects* / Q000502:physiology; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome; D014227:Triazines / Q000008:administration & dosage*; D055815:Young Adult
D014227:Triazines; D002220:Carbamazepine; D000077213:Lamotrigine