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Neurobehavioral Effects of Anticonvulsants FREE

Michael R. Trimble, FRCP, FRCPsych
[+] Author Affiliations

Reprint requests to The National Hospital for Neurology and Neurosurgery, Queen Square, London, England WC1N 3BG (Dr Trimble).


JAMA. 1991;265(10):1307-1308. doi:10.1001/jama.1991.03460100109037
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A controversial issue in epilepsy research involves the effects of anticonvulsant drugs on cognitive function and behavior. The article by Dikmen and colleagues1 in this issue of The Journal is an important contribution to the subject, especially as it addresses the issue in nonepileptic subjects. Thus, one problem of much work in this area relates to experimental design when the illness in question contaminates the results of any study. Seizures thus impair cognition, and anticonvulsant drugs, by changing seizure frequency, can render interpretation of data difficult. There are several ways to tackle this; one relates to using nonepileptic populations.

An earlier attempt in this direction was made by Thompson and colleagues.2 They used healthy volunteers who were prescribed anticonvulsant drugs in clinically equivalent doses for 14 days, testing cognitive function in a double-blind crossover study against placebo. Phenytoin significantly impaired performance on a variety of tasks, and in

REFERENCES

Dikmen SS, Temkin NR, Miller B, MachamerJ, Winn HR.  Neurobehavioral effects of phenytoin prophylaxis of posttraumatic seizures . JAMA. 1991;;265:1271-1277.
Thompson PJ, Huppert FA, Trimble MR.  Phenytoin and cognitive functions: effects on normal volunteers . Br J Soc Clin Psychol. 1981;;20:155-162.
Thompson PJ, Trimble MR.  Comparative effects of anticonvulsant drugs on cognitive functioning . Br J Clin Pract. 1982;;18( (suppl) ):154-159.
Gallassi R, Morreale A, Lorusso S, Procaccianti G, Lugarasi E, Baruzzi A.  Carbamazepine and phenytoin: comparison of cognitive effects in epileptic patients during monotherapy and withdrawal . Arch Neurol. 1988;;45:892-894.
Trimble MR.  Anticonvulsant drugs and cognitive function: a review of the literature . Epilepsia. 1987;;28( (suppl) ):S37-S45.
Dodrill CB, Temkin NR.  Motor speed is a contaminating factor in evaluating the'cognitive'effects of phenytoin . Epilepsia. 1989;;30:453-457.
Duncan JS, Shorvon SD, Trimble MR.  Effects of removal of phenytoin, carbamazepine, and valproate on cognitive function . Epilepsia. 1990;;31:584-591.
Dodrill CB, Troupin AS.  Psychotropic effects of carbamazepine in epilepsy: a double-blind comparison with phenytoin . Neurology. 1977;;27:1023-1028.
Dodrill CB, Troupin AS.  Neuropsychological effects of carbamazepine and phenytoin: a reanalysis . Neurology. 1991;;41:141-143.
Smith DB, Mattson RH, Cramer JA, et al.  Results of a nationwide Veterans Administration Cooperative Study comparing the efficacy and toxicity of carbamazepine, phenobarbital, phenytoin and primidone . Epilepsia. 1987;; 28( (suppl) ):S50-S58.
Hirtz DG, Nelson KB.  Cognitive effects of antiepileptic drugs . In: Pedley TA, Meldrum BS. Recent Advances in Epilepsy, II . New York, NY: Churchill Livingstone; 1988;:161-181.
MacGuire A, Duncan J, Trimble MR.  Cognitive effects of vigabatrin . Epilepsia . In press.

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Dikmen SS, Temkin NR, Miller B, MachamerJ, Winn HR.  Neurobehavioral effects of phenytoin prophylaxis of posttraumatic seizures . JAMA. 1991;;265:1271-1277.
Thompson PJ, Huppert FA, Trimble MR.  Phenytoin and cognitive functions: effects on normal volunteers . Br J Soc Clin Psychol. 1981;;20:155-162.
Thompson PJ, Trimble MR.  Comparative effects of anticonvulsant drugs on cognitive functioning . Br J Clin Pract. 1982;;18( (suppl) ):154-159.
Gallassi R, Morreale A, Lorusso S, Procaccianti G, Lugarasi E, Baruzzi A.  Carbamazepine and phenytoin: comparison of cognitive effects in epileptic patients during monotherapy and withdrawal . Arch Neurol. 1988;;45:892-894.
Trimble MR.  Anticonvulsant drugs and cognitive function: a review of the literature . Epilepsia. 1987;;28( (suppl) ):S37-S45.
Dodrill CB, Temkin NR.  Motor speed is a contaminating factor in evaluating the'cognitive'effects of phenytoin . Epilepsia. 1989;;30:453-457.
Duncan JS, Shorvon SD, Trimble MR.  Effects of removal of phenytoin, carbamazepine, and valproate on cognitive function . Epilepsia. 1990;;31:584-591.
Dodrill CB, Troupin AS.  Psychotropic effects of carbamazepine in epilepsy: a double-blind comparison with phenytoin . Neurology. 1977;;27:1023-1028.
Dodrill CB, Troupin AS.  Neuropsychological effects of carbamazepine and phenytoin: a reanalysis . Neurology. 1991;;41:141-143.
Smith DB, Mattson RH, Cramer JA, et al.  Results of a nationwide Veterans Administration Cooperative Study comparing the efficacy and toxicity of carbamazepine, phenobarbital, phenytoin and primidone . Epilepsia. 1987;; 28( (suppl) ):S50-S58.
Hirtz DG, Nelson KB.  Cognitive effects of antiepileptic drugs . In: Pedley TA, Meldrum BS. Recent Advances in Epilepsy, II . New York, NY: Churchill Livingstone; 1988;:161-181.
MacGuire A, Duncan J, Trimble MR.  Cognitive effects of vigabatrin . Epilepsia . In press.
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