How can we overcome neuropsychological adverse effects of antiepileptic drugs?

How can we overcome neuropsychological adverse effects of antiepileptic drugs?

Expert Opin Pharmacother. 2017 Mar 17;:

Authors: Witt JA, Helmstaedter C

Abstract
Antiepileptic pharmacotherapy can have a negative or positive impact on cognition and behavior. Besides individual susceptibilities (in terms of idiosyncratic reactions), the risk of adverse drug effects largely depends on treatment decisions. Therefore practical strategies to prevent neuropsychological side effects comprise (1.) selecting antiepileptic drugs (AEDs) with superior neuropsychological side effect profiles, (2.) restricting the individual drug load (target doses and number of concurrent AEDs), (3.) considering pharmacokinetics and pharmacodynamic interactions, and (4.) preferring slow titration rates (5.) informing about and (6.) monitoring of eventual side effects. To counteract side effects by (7.) prescribing cognition-enhancing pharmacological agents (nootropics) or (8.) offering cognitive trainings are at best options of last resort. Overall, it is essential that the pharmacological treatment of epileptic seizures is not only guided by its efficacy, but also by neuropsychological side effects. For the reliable detection and monitoring of cognitive side effects, a routine neuropsychological screening along with relevant treatment changes is required. If complete seizure control cannot be achieved with acceptable side effects, an individual balancing of the degree of seizure control and AED-related side effects becomes necessary striving for a constellation that provides the highest possible quality of life.

PMID: 28303728 [PubMed - as supplied by publisher]

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