Albert P. Aldenkamp

Effect of epilepsy, seizures and epileptiform EEG discharges on cognitive function

Patients with an established diagnosis of epilepsy were included in three groups on the basis of the absence (Group 2) or presence (Group 3) of epileptiform EEG discharges or subtle seizures (Group 4) during the cognitive assessment procedure. A separate age‐matched non‐epileptic control group (Group 1) was formed. Twenty‐five patients were included in each of the four groups. Thus, a total of 100 patients were investigated. The patients were assessed with continuous 21‐channel EEG and video‐monitoring, combined with cognitive testing. The results show consistently lower performance on cognitive tests for Group 4, the group with subtle seizures. The difference with the control group was significant for the intelligence subtests and for the complex information processing test (p<0.05). No transient cognitive impairment was found. The results are discussed in the light of possible factors that may be responsible for the lower test‐scores in the patients of Group 4: both the ictal effects of the seizures themselves, postictal effects and the effects of the epileptiform EEG discharges may have had an impact on cognitive performance. Finally the absence of evidence for transient cognitive impairment in a group with frequent epileptiform EEG discharges is discussed in detail.

Cognitive effects of lamotrigine as first-line add-on in patients with localization-related (partial) epilepsy

The objective of this study is to explore clinically relevant central cognitive side effects of lamotrigine (LMT) in patients with localization-related (partial) epilepsy. Attentional processes, short-term memory, and speed factors (motor and mental speed) were investigated in an open-label first-line add-on clinical nonrandomized study with carbamazepine (Tegretol-CR) as baseline medication. Twenty-five patients were assessed at baseline (monotherapy carbamazepine) and after 5 months of add-on treatment with lamotrigine. During this 5 month period, the baseline medication was unchanged. Evidence supported the hypothesis that the cognitive profile of lamotrigine is similar to that of carbamazepine. None of the test scores showed a statistically significant decrease after adding lamotrigine, and most of the changes were in the positive direction. The most marked change was that patients showed fewer complaints after 5 months of add-on treatment with lamotrigine.

Test-retest variability in children with epilepsy — a comparison of WISC-R profiles

Reports of test-retest variability appear recurrently in relation to epilepsy. To date, the amount of information available on the stability of cognitive profiles over a number of years is limited. In this study, 45 children were assessed, using the Wechsler Intelligence Test for Children - Revised (WISC-R). The children were retested after a period of at least 2 years. A group of 20 children was tested 3 times. The average follow-up period was 4.2 years. Although most subjects in our sample had a high seizure frequency and continued to have their seizures during the period of follow-up, a marked stability of cognitive profiles is found over a period of time. These profiles show low scores for the subtests Information, Coding, Digit Span, Vocabulary and resemble profiles reported in other studies on subjects with intractable epilepsies.

γ-Vinyl GABA (Vigabatrin) and Mood Disturbances

Summary: We explored factors that may predispose patients to adverse mood effects during treatment with vigabatrin (γ‐vinyl GABA; VGB): mood disorders before VGB treatment, type of epilepsy, seizure type and seizure frequency, type and number of comedication, and VGB dose. The clinical relevance of such a study is that it may help identify circumstances in which VGB should be administered with caution. Seventy‐three patients (40 males, 33 females), all with refractory epilepsies, who received VGB as add‐on therapy, were assessed by the Amsterdamse Stemmingslyst (ASL), a mood‐rating scale, before the start of treatment, and demographic and clinical data were recorded. The patients were followed for 6 months after the start of VGB treatment. Treatment with VGB had to be discontinued in 38 patients (52% of the total sample). Mood problems were the main reason for discontinuation in 9 (12·3% of the total sample). In 6 other patients, mood problems were mentioned as the reason for discontinuing treatment, in combination with lack of drug efficacy. Development of adverse mood effects could not be predicted by a specific mood profile on the ASL. Before treatment, the “mood problems discontinuation group” did not show extreme scores for any assessed areas of mood and no significant differences from other patients were noted on the mood scales. Neither did clinical or demographic data show statistically confirmed specific characteristics for the mood problems discontinuation group, though the patients tended to use more antiepileptic drugs (AEDs) as cotherapy, to have a slightly lower daily dose of VGB, to be slightly older, and were mostly female. Especially the trend toward a relation with AED as comedication deserves further study.

Epilepsy care in the Netherlands

In this article models of epilepsy care in the Netherlands are outlined. Mostly this care is aimed at people with uncontrolled epilepsy who may have suffered from the adverse effects of ignorance, prejudice and even discrimination. Many of these adverse factors should be avoidable in future as the educational programmes for people with epilepsy, professionals and the general public take full effect. Meanwhile there is a great deal that can be done to rehabilitate people whose seizures are a problem and whose social abilities fall short of the standards that are required for independent and self-fulfilling living in any society. The models of care described are very sophisticated and they have been developed over many years. They require well-trained and motivated staff and sometimes elaborate and expensive medical diagnostic equipment. But this should not put anybody off as the principles behind any model of care should be the same: Accurate diagnosis. Optimal drug and other treatment (this should be optimal treatment available in that country). Education of the patient and family about all aspects of epilepsy. Opportunity to share experiences. A multidisciplinary approach to identified problems (a multidisciplinary approach can be taken by one person, although a team of people from different disciplines is ideal.) Objectives agreed by all participants.