Arif Hiba, Buchsbaum Richard, Weintraub David, Pierro Joanna, Resor Stanley R, Hirsch Lawrence J
Comprehensive Epilepsy Center, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Epilepsy Behav. 2009 Jan;14(1):202-9. doi: 10.1016/j.yebeh.2008.10.017. Epub 2008 Dec 17.
Subjective cognitive side effects (CSEs) are common in patients taking antiepileptic drugs (AEDs). The objective of this study was to predict which patients are at risk for CSEs, and compare the CSE profiles of all commonly used AEDs. In this nonrandomized retrospective study, medical records of 1694 adult outpatients with epilepsy seen at our center over a 5-year period who had taken one or more AEDs were examined. Non-AED predictors of CSEs were investigated, and rates of AED-related CSEs were compared in 1189 patients (546 on monotherapy) newly started on an AED at our center. The average rate of AED-related intolerable CSEs (leading to dosage change or discontinuation) was 12.8%. On multivariate analysis, no significant non-AED predictors of CSEs were found. Significantly more intolerable CSEs were attributed to topiramate (21.5% of 130 patients) than to most other AEDs, including carbamazepine (9.9%), gabapentin (7.3%), levetiracetam (10.4%), lamotrigine (8.9%), oxcarbazepine (11.6%), and valproate (8.3%). CSE rates with zonisamide (14.9%) were significantly higher than those for gabapentin and lamotrigine. After exclusion of CSEs during the first 8 weeks of therapy, rates of CSEs were lower, but relative differences remained unchanged. In monotherapy, significantly more intolerable CSEs occurred with topiramate (11.1% of 18 patients) than with carbamazepine or valproate, and both phenytoin and zonisamide were associated with more CSEs than valproate. From this study, it can be concluded that intolerable patient-reported CSEs are most common with topiramate, followed by zonisamide, phenytoin, and oxcarbazepine. They are least likely to be reported with gabapentin, valproate, lamotrigine, carbamazepine, and levetiracetam.
主观认知副作用（CSEs）在服用抗癫痫药物（AEDs）的患者中很常见。本研究的目的是预测哪些患者有发生CSEs的风险，并比较所有常用AEDs的CSEs特征。在这项非随机回顾性研究中，我们检查了在5年期间到我们中心就诊的1694例成年癫痫门诊患者的病历，这些患者服用过一种或多种AEDs。我们调查了CSEs的非AED预测因素，并比较了在我们中心新开始使用AED的1189例患者（546例接受单药治疗）中与AED相关的CSEs发生率。与AED相关的无法耐受的CSEs（导致剂量改变或停药）的平均发生率为12.8%。多因素分析未发现CSEs的显著非AED预测因素。与包括卡马西平（9.9%）、加巴喷丁（7.3%）、左乙拉西坦（10.4%）、拉莫三嗪（8.9%）、奥卡西平（11.6%）和丙戊酸盐（8.3%）在内的大多数其他AEDs相比，托吡酯导致的无法耐受的CSEs显著更多（130例患者中的21.5%）。唑尼沙胺的CSEs发生率（14.9%）显著高于加巴喷丁和拉莫三嗪。在排除治疗前8周内的CSEs后，CSEs发生率较低，但相对差异保持不变。在单药治疗中，托吡酯导致的无法耐受的CSEs（18例患者中的11.1%）显著多于卡马西平或丙戊酸盐，苯妥英和唑尼沙胺导致的CSEs均多于丙戊酸盐。从这项研究可以得出结论，患者报告的无法耐受的CSEs最常见于托吡酯，其次是唑尼沙胺、苯妥英和奥卡西平。加巴喷丁、丙戊酸盐、拉莫三嗪、卡马西平和左乙拉西坦导致CSEs的可能性最小。
