Hessen Erik, Lossius Morten I, Reinvang Ivar, Gjerstad Leif
Helse Øst Health Services, Department of Neurology, Akershus University Hospital, Akershus, Norway.
Epilepsia. 2006 Dec;47(12):2038-45. doi: 10.1111/j.1528-1167.2006.00805.x.
All major antiepileptic drugs (AEDs) have been reported to be associated with cognitive side effects. Uncertainty exists regarding the degree of cognitive effects, primarily because many studies do not adhere to basic standards of methodology and design. The aim of this study was to assess the effect of discontinuation of AEDs in patients receiving monotherapy on measures of attention, reaction time, and speed of information processing.
The 150 subjects who had been seizure free>2 years on drug monotherapy went through a randomized, double-blind, placebo-controlled study. Each patient was included for 12 months or until seizure relapse. Cognitive function was assessed with the California Computerized Assessment Package at baseline and 7 months after discontinuation.
The major finding in this study is that discontinuation of major AEDs significantly improved performance on tests that require complex cognitive processing under time pressure. The difference in speed of cognitive processing between the two groups on these tasks was between 24 to 43 ms. Simple tasks of attention and reaction time revealed no significant differences between the discontinuation group and the nondiscontinuation group. Most of the subjects in the study were medicated with carbamazepine (CBZ) and valproate (VPA). The outcome of discontinuation of CBZ was similar to the outcome for the total study population, whereas withdrawal of VPA revealed only a nonsignificant tendency in the same direction.
The results suggest that seizure-free epilepsy patients receiving monotherapy can obtain improvement in cognitive function if they discontinue AED treatment.
据报道，所有主要的抗癫痫药物（AEDs）都与认知副作用有关。认知影响的程度存在不确定性，主要是因为许多研究未遵循基本的方法学和设计标准。本研究的目的是评估接受单一疗法的患者停用AEDs对注意力、反应时间和信息处理速度测量指标的影响。
150名接受单一药物治疗且无癫痫发作超过2年的受试者参与了一项随机、双盲、安慰剂对照研究。每位患者纳入研究12个月或直至癫痫复发。在基线期和停药7个月后，使用加利福尼亚计算机化评估包评估认知功能。
本研究的主要发现是，停用主要的AEDs显著改善了在时间压力下需要复杂认知处理的测试中的表现。两组在这些任务上的认知处理速度差异在24至43毫秒之间。注意力和反应时间的简单任务在停药组和未停药组之间未显示出显著差异。研究中的大多数受试者使用卡马西平（CBZ）和丙戊酸盐（VPA）进行治疗。停用CBZ的结果与整个研究人群的结果相似，而停用VPA仅显示出相同方向的不显著趋势。
结果表明，接受单一疗法的无癫痫发作的癫痫患者如果停用AED治疗，认知功能可得到改善。
