title: The effect of phenobarbitone on cognition in adult patients with new onset epilepsy: a multi-centric prospective study from India.
abstract: OBJECTIVE
  In view of the conflicting results of cognitive and behavioral consequences of PB, the present study was planned to analyze its efficacy, serial neuropsychological functions and its impact on psychosocial functioning in adults with epilepsy while on phenobarbitone (PB).
  
  
  METHODS
  This prospective multi-centric study carried out across 4 centers in India included 75 adult patients of ≥18 years (M:F=52:23; age: 27.3 ± 8.5 years) with epilepsy who were prescribed phenobarbitone and underwent serial standardized neuropsychological assessment (NIMHANS battery for adults) at baseline, 1 month, 3 months, 6 months and 12 months. The demographic, seizure details and outcome measures were recorded.
  
  
  RESULTS
  Of the 75 patients, 63 had completed clinical and neuropsychological assessment, i.e. visit 1 (baseline), visit 4 (6 months) and visit 5 (12 months). There was no deterioration rather an improvement during the follow visits in all the neuropsychological functions. The results indicate that 16 neuropsychological variables changed significantly, viz. mental speed (p<0.001), sustained attention (p<0.001), focused attention (p<0.002), planning (p<0.001), concept formation (p<0.05), set shifting (p<0.001), verbal learning (p<0.0001), verbal memory (p<0.0001), visual memory (p<0.0001) and intelligence (p<0.001). The scales measuring the outcome of psychosocial functioning significantly changed during follow up included happiness (p<0.002), Impact of Epilepsy on patient's life (p<0.02), A-B Neuropsychological Assessment (p<0.015), HADS anxiety (p<0.001) and emotional disorder (p<0.006). There was a significant reduction in seizure severity as measured by Liverpool Seizure Severity Scale (p<0.002) and seizure freedom was maintained.
  
  
  CONCLUSIONS
  This study demonstrated that phenobarbitone is effective, well tolerated AED and do not have cognitive impairment over one year. There was variable but distinct improvement in cognition and psychosocial functioning, and effective seizure control could be one of the factor for it.
authors.affiliation: Department of Neurology, NIMHANS, Bangalore, India.
authors.forename: P
authors.initials: P
authors.lastname: Satischandra
authors.affiliation: Department of Clinical Psychology, NIMHANS, Bangalore, India.
authors.forename: S L
authors.initials: SL
authors.lastname: Rao
authors.affiliation: Department of Neurology, KEM Hospital, Mumbai, India.
authors.forename: S
authors.initials: S
authors.lastname: Ravat
authors.affiliation: Department of Neurology, NIMS, Hyderabad, India.
authors.forename: S
authors.initials: S
authors.lastname: Jayalakhsmi
authors.affiliation: Department of Neurology, BIN, Kolkata, India.
authors.forename: A
authors.initials: A
authors.lastname: Senapathy
authors.affiliation: Department of Clinical Psychology, KEM Hospital, Mumbai, India.
authors.forename: Urvashi
authors.initials: U
authors.lastname: Shah
authors.affiliation: Department of Clinical Psychology, NIMS, Hyderabad, India.
authors.forename: M S
authors.initials: MS
authors.lastname: Shunmukhi
authors.affiliation: Department of Clinical Psychology, BIN, Kolkata, India.
authors.forename: Aparna
authors.initials: A
authors.lastname: Dutta
authors.affiliation: Medical Services, Abbott Healthcare Pvt. Ltd., Mumbai, India.
authors.forename: Q
authors.initials: Q
authors.lastname: Mukaddam
authors.affiliation: Medical Services, Abbott Healthcare Pvt. Ltd., Mumbai, India.
authors.forename: M
authors.initials: M
authors.lastname: Naik
authors.affiliation: Department of Biostatistics, NIMHANS, Bangalore, India.
authors.forename: D K
authors.initials: DK
authors.lastname: Subbakrishna
authors.affiliation: Department of Neurology, NIMHANS, Bangalore, India. Electronic address: sanjib_sinha2004@yahoo.co.in.
authors.forename: S
authors.initials: S
authors.lastname: Sinha
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D004827:Epilepsy / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D009483:Neuropsychological Tests; D010634:Phenobarbital / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012640:Seizures / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D010634:Phenobarbital
keywords: Cognition; Neuropsychological assessment; Phenobarbitone