Mills Kenneth C, Drazkowski Joseph F, Hammer Anne E, Caldwell Paul T, Kustra Robert P, Blum David E
Profile Associates, Chapel Hill, NC, United States.
Epilepsy Res. 2008 Feb;78(2-3):140-6. doi: 10.1016/j.eplepsyres.2007.10.013. Epub 2007 Dec 21.
A subsample of 67 adult patients with partial seizures participating in a randomized, double-blind study comparing the cognitive effects of adjunctive lamotrigine (LTG) and adjunctive topiramate (TPM) was administered Performance On-Line (POL) in addition to a battery of neuropsychological tests at baseline, week 8 and week 16 of treatment. The POL is a self-administered computer task that measures scanning, divided-attention, and the effective field of view. Although the POL does not measure driving performance, POL scores are correlated with driving performance. The results show that adjunctive TPM, but not adjunctive LTG, negatively impacted cognition. Both simple target identification and divided-attention performance on POL were compromised in the TPM group but not in the LTG group. The relative POL impairment associated with chronic TPM treatment was similar to that observed with the acute effects of alcohol with a breath level of .045% or a low dose of alprazolam (0.5mg). Thus, driving-related visual and cognitive skills were compromised by adjunctive TPM treatment. Therapeutic doses of adjunctive TPM pose a potential risk of impaired scanning and divided-attention skills.
一项针对67例部分性癫痫成年患者的随机双盲研究，比较了辅助使用拉莫三嗪（LTG）和托吡酯（TPM）的认知效果。在治疗的基线、第8周和第16周，除了一系列神经心理学测试外，还对这些患者进行了在线表现（POL）测试。POL是一项自我管理的计算机任务，用于测量扫描、分散注意力和有效视野。虽然POL不测量驾驶性能，但POL分数与驾驶性能相关。结果表明，辅助使用TPM而非LTG对认知有负面影响。TPM组在POL上的简单目标识别和分散注意力表现均受到损害，而LTG组则未受影响。与慢性TPM治疗相关的POL相对损害与呼气酒精含量为0.045%或低剂量阿普唑仑（0.5mg）的急性效应所观察到的损害相似。因此，辅助使用TPM治疗会损害与驾驶相关的视觉和认知技能。辅助使用TPM的治疗剂量存在扫描和分散注意力技能受损的潜在风险。
