Department of Neurology, NIMHANS, Bangalore, India.
Department of Clinical Psychology, NIMHANS, Bangalore, India.
Epilepsy Res. 2014 Jul;108(5):928-36. doi: 10.1016/j.eplepsyres.2014.03.012. Epub 2014 Mar 27.
In view of the conflicting results of cognitive and behavioral consequences of PB, the present study was planned to analyze its efficacy, serial neuropsychological functions and its impact on psychosocial functioning in adults with epilepsy while on phenobarbitone (PB).
This prospective multi-centric study carried out across 4 centers in India included 75 adult patients of ≥18 years (M:F=52:23; age: 27.3 ± 8.5 years) with epilepsy who were prescribed phenobarbitone and underwent serial standardized neuropsychological assessment (NIMHANS battery for adults) at baseline, 1 month, 3 months, 6 months and 12 months. The demographic, seizure details and outcome measures were recorded.
Of the 75 patients, 63 had completed clinical and neuropsychological assessment, i.e. visit 1 (baseline), visit 4 (6 months) and visit 5 (12 months). There was no deterioration rather an improvement during the follow visits in all the neuropsychological functions. The results indicate that 16 neuropsychological variables changed significantly, viz. mental speed (p<0.001), sustained attention (p<0.001), focused attention (p<0.002), planning (p<0.001), concept formation (p<0.05), set shifting (p<0.001), verbal learning (p<0.0001), verbal memory (p<0.0001), visual memory (p<0.0001) and intelligence (p<0.001). The scales measuring the outcome of psychosocial functioning significantly changed during follow up included happiness (p<0.002), Impact of Epilepsy on patient's life (p<0.02), A-B Neuropsychological Assessment (p<0.015), HADS anxiety (p<0.001) and emotional disorder (p<0.006). There was a significant reduction in seizure severity as measured by Liverpool Seizure Severity Scale (p<0.002) and seizure freedom was maintained.
This study demonstrated that phenobarbitone is effective, well tolerated AED and do not have cognitive impairment over one year. There was variable but distinct improvement in cognition and psychosocial functioning, and effective seizure control could be one of the factor for it.
鉴于苯巴比妥对认知和行为后果的结果存在冲突，本研究计划分析其在服用苯巴比妥的成年人中的疗效、连续神经心理学功能及其对社会心理功能的影响。
这项在印度 4 个中心进行的前瞻性多中心研究纳入了 75 名年龄≥18 岁的成年癫痫患者（男：女=52：23；年龄：27.3±8.5 岁），他们服用苯巴比妥并接受连续的标准化神经心理学评估（NIMHANS 成人电池）在基线、1 个月、3 个月、6 个月和 12 个月时进行。记录人口统计学、癫痫发作详细信息和结果测量。
在 75 名患者中，有 63 名完成了临床和神经心理学评估，即就诊 1（基线）、就诊 4（6 个月）和就诊 5（12 个月）。在随访期间，所有神经心理学功能均无恶化，反而有所改善。结果表明，16 个神经心理学变量发生了显著变化，即：心理速度（p<0.001）、持续注意力（p<0.001）、集中注意力（p<0.002）、计划（p<0.001）、概念形成（p<0.05）、思维转换（p<0.001）、语言学习（p<0.0001）、语言记忆（p<0.0001）、视觉记忆（p<0.0001）和智力（p<0.001）。在随访期间，衡量社会心理功能结果的量表发生了显著变化，包括幸福感（p<0.002）、癫痫对患者生活的影响（p<0.02）、A-B 神经心理学评估（p<0.015）、HADS 焦虑（p<0.001）和情绪障碍（p<0.006）。利物浦癫痫严重程度量表（p<0.002）测量的癫痫严重程度显著降低，且保持无癫痫发作。
本研究表明，苯巴比妥是一种有效、耐受良好的抗癫痫药，在一年以上不会导致认知障碍。认知和社会心理功能有不同程度的改善，有效控制癫痫发作可能是其中的一个因素。
