Brandt Christian, Lahr Denise, May Theodor W
Bethel Epilepsy Centre, Mara Hospital, 33617 Bielefeld, Germany; Society for Epilepsy Research, 33617 Bielefeld, Germany.
Bethel Epilepsy Centre, Mara Hospital, 33617 Bielefeld, Germany.
Epilepsy Behav. 2015 Apr;45:261-4. doi: 10.1016/j.yebeh.2014.12.043. Epub 2015 Apr 2.
Topiramate (TPM) is an effective antiepileptic drug (AED). A high proportion of patients, however, experiences cognitive adverse events (CAEs), especially in verbal fluency, memory spans, and working memory. To our knowledge, CAEs of TPM have not been studied systematically in patients with intellectual disability (ID). This may be due to the fact that many of those patients are not able to follow test instructions properly and that neuropsychological instruments are not validated for that group. Cognitive deterioration in patients with ID may thus easily be overlooked. Topiramate is in frequent use in persons with ID. We included 26 consecutive patients with epilepsy and ID in this observational study who had undergone neuropsychological examinations as part of clinical routine before and after the introduction of TPM into the therapeutic regimen (n=4) or before and after the withdrawal of TPM (n=22). Examinations under TPM showed reduced cognitive speed, reduced verbal memory, reduced verbal fluency, and reduced flexibility compared to examinations without TPM. Despite some limitations (especially small sample size, high interindividual variation of the results dependent on the degree of ID, effects of other - limited - changes in the therapeutic regimen), our study indicates that TPM in persons with epilepsy and ID may lead to CAEs comparable to those in persons with normal intelligence. Neuropsychological testing is mandatory in order not to miss CAEs that might severely impair quality of life.
托吡酯（TPM）是一种有效的抗癫痫药物（AED）。然而，相当一部分患者会出现认知不良事件（CAEs），尤其是在语言流畅性、记忆广度和工作记忆方面。据我们所知，尚未对智力残疾（ID）患者中TPM的CAEs进行系统研究。这可能是由于许多此类患者无法正确遵循测试指示，且神经心理学测试工具未针对该群体进行验证。因此，ID患者的认知衰退可能很容易被忽视。TPM在ID患者中经常使用。在这项观察性研究中，我们纳入了26例连续的癫痫合并ID患者，他们在TPM引入治疗方案之前和之后（n = 4）或TPM撤药之前和之后（n = 22）接受了作为临床常规一部分的神经心理学检查。与未使用TPM的检查相比，使用TPM时的检查显示认知速度降低、言语记忆减退、言语流畅性降低以及灵活性降低。尽管存在一些局限性（特别是样本量小、结果的个体间差异大取决于ID程度、治疗方案中其他有限变化的影响），但我们的研究表明，癫痫合并ID患者使用TPM可能会导致与智力正常者相当的CAEs。为了不遗漏可能严重损害生活质量的CAEs，神经心理学测试是必不可少的。
