Behavioral profiles of anti-epileptic drugs in patients with epilepsy

Epilepsy affects different domains of an individual's life: in addition to health, independence, education and employment are all tainted. Beyond seizures, changes in mental health, behavioral alterations and variable cognitive function are central to epilepsy. Several studies have explored the relationship between behavioral impairment and seizure-related variables. In more recent years, particular emphasis has been placed on the clinical challenge presented by anti-epileptic drugs (AEDs). AEDs have various mechanisms of action and therefore generate a wide and diverse spectrum of anticonvulsant, psychiatric, and adverse effect profiles. AEDs may be presented in two classes, divided according to predominant psychotropic profile. The first group consists of valproate, gabapentin, tiagabine and vigabatrin. This cluster is characterized by potentiation of gamma-aminobutyric acid inhibitory neurotransmission. Resultant effects include cognitive slowing, anxiolytic as well anti-manic effects. Conversely, a second cluster is defined by predominantly glutamate excitatory neurotransmission. This cluster includes lamotrigine and felbamate, and is associated with activating and anti-depressant effects. In accordance with this dual classification system, the present chapter provides a detailed description of the behavioral profile of the newer AEDs. Additionally, a brief discussion on aspects such as clinical indications, pharmacology, toxicology, efficacy and tolerability is included. It is essential that AEDs therapy offers an acceptable balance between optimum seizure control and minimal disturbance to behavior and cognition.