Changes in cognition after introduction or withdrawal of zonisamide versus topiramate in epilepsy patients: A retrospective study using Bayes statistics.
Adolescent
Adult
Anticonvulsants
/ pharmacology
Bayes Theorem
Cognition
/ drug effects
Epilepsy
/ drug therapy
Executive Function
/ drug effects
Female
Humans
Longitudinal Studies
Male
Middle Aged
Retrospective Studies
Topiramate
/ pharmacology
Withholding Treatment
/ trends
Young Adult
Zonisamide
/ pharmacology
antiepileptic drugs
cognition
epilepsy
neuropsychology
topiramate
zonisamide
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
17
03
2020
revised:
16
05
2020
accepted:
17
05
2020
pubmed:
20
6
2020
medline:
1
12
2020
entrez:
20
6
2020
Statut:
ppublish
Résumé
We aim to evaluate the impact of zonisamide (ZNS) compared to topiramate (TPM) on cognition in patients with epilepsy. Although the risk of cognitive side effects has been clearly demonstrated for TPM, comparable side effects in ZNS have been suggested but evidence from studies is inconclusive. In this retrospective observational study, we analyzed patients' records from before and after introduction or withdrawal of ZNS vs TPM. Data were gathered during routine clinical care protocols. Standardized monitoring of executive functions (EpiTrack), verbal memory (short version of verbaler lern- und merkfähigkeitstest, VLMT), and subjective health (extended Adverse Events Profile; quality of life in epilepsy inventory, QOLIE-10) was performed in 73 patients when TPM (n = 45) or ZNS (n = 28) was introduced and 62 patients when TPM (n = 29) or ZNS (n = 33) was withdrawn. The data were analyzed using Bayes statistics that quantify evidence for or against an effect through Bayes factors (BFs). There was decisive evidence for a negative effect of adjunctive ZNS and TPM on executive function (BF = 965.08) and a positive effect of their withdrawal (BF = 429.51). The ZNS effect seemed smaller, although the difference was inconclusive. Verbal memory and subjective quality of life were not significantly affected. Subjectively, ZNS was connected to lower anxiety and fewer headaches, whereas TPM had a perceived effect on weight, fluent speech and comprehension, headaches, and balance. This is the first study to provide objective evidence for a considerable negative effect of ZNS treatment on executive function in a naturalistic treatment setting. Comparable to the well-known TPM effect, cognition worsens with adjunction and recovers with withdrawal of ZNS. However, the majority of patients do not show a significant negative effect, suggesting disparate susceptibilities to adverse events. The findings emphasize the need for routine monitoring of cognitive side effects to identify early on those patients who are negatively affected by new AED.
Substances chimiques
Anticonvulsants
0
Topiramate
0H73WJJ391
Zonisamide
459384H98V
Types de publication
Comparative Study
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1481-1490Informations de copyright
© 2020 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.
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