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Efficacy and cognitive side effects of tiagabine and topiramate in patients with epilepsy.
- Source :
-
Epilepsy & behavior : E&B [Epilepsy Behav] 2005 May; Vol. 6 (3), pp. 373-81. - Publication Year :
- 2005
-
Abstract
- Objective: Whereas the efficacy of the newer antiepileptic drugs (AEDs) is well established, there remain questions regarding their cognitive side effects. Therefore, we performed a comparative open randomized trial with TPM and TGB as add-on therapy, with particular consideration of cognition, mood, and health-related quality of life (HRQOL).<br />Methods: Forty-one patients with refractory epilepsy were randomly assigned to one of the two treatment groups (TPM vs TGB) and received neuropsychological testing at baseline (T1), after titration (3 months, T2), and during the maintenance phase (another 3 months, T3). Tests included measures of intelligence, attention, working memory, episodic memory, language, and self-report questionnaires regarding mood and HRQOL. Twenty patients (8 TPM, 12 TGB) discontinued the trial for different reasons (no group difference).<br />Results: Seizure outcome (intention-to-treat analysis) was comparably good in both groups (8.1% seizure free, 29.7% seizure reduction>50%). From baseline to after the titration paired sample t tests revealed significant deterioration in verbal fluency, language comprehension, working memory, and visual block tapping under TPM and a deterioration in verbal memory (delayed free recall) in the TGB group. These functions remained stable in the maintenance phase. Self-report measures initially indicated concerns about AED side effects in both groups and concerns about worse cognitive functioning and depression under TPM. In the maintenance phase the TGB group reported feeling a lack of energy, whereas patients on TPM demonstrated improvement on all QOLIE scales on a descriptive level.<br />Conclusion: This study demonstrates the comparable efficacy of TPM and TGB. Consistent with previous reports, TPM but not TGB appears to be associated with persistent negative cognitive side effects on frontal lobe-associated functions, the degree of which may be estimated by the fact that this effect was observed with a very small sample size. In contrast, in patients taking TPM, initially negatively affected HRQOL returns to baseline in the long run on a descriptive level. The latter finding may be interpreted in accordance with the observation that objective performance and subjective self-report under TPM can be dissociated.
- Subjects :
- Adolescent
Adult
Attention drug effects
Drug Evaluation
Female
Humans
Intelligence drug effects
Male
Memory, Short-Term drug effects
Middle Aged
Mood Disorders etiology
Neuropsychological Tests
Tiagabine
Topiramate
Treatment Outcome
Verbal Behavior drug effects
Anticonvulsants adverse effects
Cognition Disorders etiology
Epilepsy drug therapy
Fructose adverse effects
Fructose analogs & derivatives
Nipecotic Acids adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1525-5050
- Volume :
- 6
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Epilepsy & behavior : E&B
- Publication Type :
- Academic Journal
- Accession number :
- 15820346
- Full Text :
- https://doi.org/10.1016/j.yebeh.2005.01.002