Newer Anticonvulsants: Dosing Strategies and Cognition in Treating Patients With Mood Disorders and Epilepsy

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Background: Anticonvulsants are employed to treat a variety of disorders. The most common adverse side effects of anticonvulsants are mediated via the central nervous system. Examples include sedation, dizziness, psychomotor slowing, and impairment of attention, memory, and other cognitive functions. Since multiple new anticonvulsants have been introduced in recent years, the question arises as to the frequency and magnitude of their cognitive side effects. Method: Experimental design flaws in assessing the cognitive effects of anticonvulsants were reviewed. A MEDLINE search of the medical literature was conducted, cross-referencing terms related to cognition and anticonvulsants. Research articles were selected based on their relevance to the topic and adherence to methodological criteria. Results: Incomplete information is available on the new anticonvulsants, but the present data suggest that some of the newer anticonvulsants possess favorable cognitive profiles. Also, the importance of dosing regimens and titration speed at drug initiation is discussed. Conclusion: All anticonvulsants possess some cognitive side effects, but differential effects can be seen. The cognitive effects of several newer anticonvulsants have been examined, but additional studies are needed to fully establish the cognitive effects of these agents. Dosage, titration rate at initiation, comedications, individual sensitivity, and underlying disease processes may influence cognitive side effects. Understanding these factors is important to maximize the benefits of anticonvulsant therapy. Cognitive side effects are one of the factors that physicians should consider in drug choice and monitoring of their patients.

J Clin Psychiatry 2003;64(suppl 8):30-34