Aldenkamp A P, Vermeulen J
Department of Neuropsychology, Meer & Bosch Epilepsy Centre, Heemstede, The Netherlands.
Seizure. 1995 Jun;4(2):95-104. doi: 10.1016/s1059-1311(95)80088-3.
This review summarizes the studies on the cognitive side-effects of two important antiepileptic drugs: phenytoin and carbamazepine. A large literature database was compiled through the DIMDI computer database and the inspection of recent reviews. Only scientific articles published in peer-reviewed journals during the last 25 years were selected. Of the 358 potentially relevant papers on cognitive effects of AEDs, a total of 16 studies have been found that have studied both carbamazepine and phenytoin. After excluding studies with designs that do not permit valid inferences regarding the cognitive effects of AEDs, only five studies remained. The evaluation of these studies reveal that our current knowledge allows us to draw conclusions about the cognitive side-effects of phenytoin and carbamazepine only with great caution. The claim in reviews that 'both drugs have an impact on cognitive function, PHT to a larger degree than CBZ' is simply not supported by valid 'high quality' data. The same is true for the overall conclusion in more recent reviews that 'drug-induced cognitive effects of these AEDs on cognitive function are probably mild or even negligible'. Apparently, the only information that we have is that the differential impact of PHT and CBZ on cognitive function is not extremely different. No conclusive and reconfirmed data are available on the absolute effects of CBZ and PHT (differences between the two drugs and a no-treatment condition). Our review summarizes some recommendations for future studies.
本综述总结了关于两种重要抗癫痫药物——苯妥英和卡马西平认知副作用的研究。通过德国医学文献与信息研究所（DIMDI）计算机数据库以及查阅近期综述，编制了一个大型文献数据库。仅选取过去25年在同行评审期刊上发表的科学文章。在358篇关于抗癫痫药物认知作用的潜在相关论文中，共发现16项研究同时涉及卡马西平和苯妥英。在排除那些设计不允许就抗癫痫药物认知作用进行有效推断的研究后，仅剩下5项研究。对这些研究的评估表明，就目前的认知而言，我们只能极为谨慎地得出关于苯妥英和卡马西平认知副作用的结论。综述中称“两种药物均对认知功能有影响，苯妥英的影响程度大于卡马西平”这一说法，根本没有有效的“高质量”数据支持。近期综述中的总体结论“这些抗癫痫药物对认知功能的药物诱导认知作用可能轻微甚至可忽略不计”亦是如此。显然，我们现有的唯一信息是，苯妥英和卡马西平对认知功能的差异影响并非极为不同。关于卡马西平和苯妥英的绝对作用（两种药物之间的差异以及与未治疗情况的差异），尚无确凿且经再次证实的数据。我们的综述总结了一些对未来研究的建议。
