title: The Cognitive Profile of Ethosuximide in Children.
abstract: BACKGROUND
  Although ethosuximide is one of the oldest antiepileptic drugs (AEDs), little information is available about the cognitive side effects of ethosuximide.
  
  
  OBJECTIVE
  The aim of this study was to investigate the cognitive profile of ethosuximide.
  
  
  METHODS
  In this cross-sectional study, we used an extensive neuropsychological test battery in patients with epilepsy aged 6-16 years who were treated with monotherapy ethosuximide. We evaluated the efficacy of the drug by seizure frequency (seizure free or not).
  
  
  RESULTS
  We included 61 patients with a mean age of 9.4 years [standard deviation (SD) 2.7] who used on average 686 mg/day (SD 245) ESM as monotherapy. ESM was effective in the majority of the patients (70 % were seizure free for at least 6 months at moment of inclusion). The total study population showed impairments of intelligence, visuomotor, and attentional function including activation/alertness. Comparisons between the well-controlled patients and patients who were not in remission showed significantly lower intelligence values and lower performance on the visual-perceptual and attentional tasks for the group with ongoing seizures. Our results suggested that the higher order cognitive dysfunctions (such as intelligence and visual-perceptual functions) may be regarded as seizure or aetiology effects and that the impaired fluid cognitive functions, such as activation/alertness, sustained auditory attention and attentional control or switching, were due to ESM.
  
  
  CONCLUSIONS
  This study suggests the attentional dysfunction resulting in psychomotor slowing and alertness deficits may be regarded as effects of ethosuximide. Although no untreated baseline assessment was available, these effects are comparable to those of other AEDs, and ethosuximide may therefore be considered an AED with only mild effects on cognition. As ethosuximide is a first-line therapy for absence seizures in childhood, and drug-induced cognitive impairment may interfere with development, learning, and academic achievement, these findings are of interest to clinicians who prescribe this drug, especially when informing parents.
authors.affiliation: Department of Behavioural Sciences, Epilepsy Centre Kempenhaeghe, P.O. Box: 61, 5590 A.B., Heeze, The Netherlands. IJffD@kempenhaeghe.nl.|School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands. IJffD@kempenhaeghe.nl.
authors.forename: Dominique M
authors.initials: DM
authors.lastname: IJff
authors.affiliation: School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands.|Departments of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Tamar M
authors.initials: TM
authors.lastname: van Veenendaal
authors.affiliation: Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands.
authors.forename: Mariette H
authors.initials: MH
authors.lastname: Debeij-van Hall
authors.affiliation: School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands.|Departments of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Jacobus F A
authors.initials: JF
authors.lastname: Jansen
authors.affiliation: Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands.|Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.|Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands.
authors.forename: Anton J A
authors.initials: AJ
authors.lastname: de Louw
authors.affiliation: School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands.|Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands.|Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.|Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
authors.forename: Marian H J M
authors.initials: MH
authors.lastname: Majoie
authors.affiliation: Department of Behavioural Sciences, Epilepsy Centre Kempenhaeghe, P.O. Box: 61, 5590 A.B., Heeze, The Netherlands.|School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands.|Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.|Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands.|Department of Neurology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Albert P
authors.initials: AP
authors.lastname: Aldenkamp
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D003071:Cognition / Q000187:drug effects; D003430:Cross-Sectional Studies; D004832:Epilepsy, Absence / Q000188:drug therapy*; D005013:Ethosuximide / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy
chemical_list: D000927:Anticonvulsants; D005013:Ethosuximide