Cognition and antiepileptic drugs

Antiepileptic drugs (AEDs) are essential for the control of epileptic seizures, but their administration carries a number of side effects which can be particularly detrimental to the patients' cognition. AEDs exert their effects by reducing excitability levels in the brain or by enhancing neuronal inhibition, leading to mainly adverse effects on cognition. Such effects differ in each individual, highlighting the importance for clinicians to carefully monitor patient drug tolerability and to ensure that the lowest effective dose is used. Older, traditional AEDs generally produce worse outcomes in terms of cognition than newer ones, however tolerability needs to be assessed on an individual level as some groups of people are more susceptible to side effects than others. Children and the elderly with epilepsy, for example, present a higher risk of developing negative cognitive effects from AEDs. Slow titration of the drug to the lowest effective dose or monotherapy can decrease the occurrence of cognitive problems. This chapter focuses on the specific effects on cognition of both old and new AEDs, in order to provide clinicians with important and often-neglected information on the neuropsychological aspects of epilepsy management.