Meador K J
Department of Neurology, Medical College of Georgia, Augusta 30912-3208.
Can J Neurol Sci. 1994 Aug;21(3):S12-6. doi: 10.1017/s0317167100040762.
All of the established antiepileptic drugs (AEDs) can produce cognitive side effects, which are increased with polypharmacy and with increasing dosage and anticonvulsant blood levels. However, cognitive side effects are usually modest for AED monotherapy with anticonvulsant blood levels within the standard therapeutic ranges. Further, these effects are offset in part by reduced seizure activity. Controversy exists regarding possible differential cognitive effects of AEDs. A large portion of the literature examining the comparative cognitive effects of AEDs is limited by inadequate study designs. When these design flaws are considered, there is no convincing evidence of clinically significant differences in cognitive side effects of AEDs except possibly for bromide, phenobarbital and benzodiazepines. The role of cognitive side effects should be kept in proper perspective when choosing AED therapy. The cognitive side effects of anticonvulsant drugs may be overt but many times are rather subtle. It is important though to be able to recognize these effects and to put them into perspective as to how they affect our patients.
所有已有的抗癫痫药物（AEDs）都会产生认知副作用，多药联合使用、剂量增加以及抗惊厥血药浓度升高时，这些副作用会加剧。然而，对于抗惊厥血药浓度处于标准治疗范围内的AED单药治疗，认知副作用通常较小。此外，癫痫发作活动减少在一定程度上抵消了这些影响。关于AEDs可能存在的不同认知效应存在争议。大量研究AEDs比较认知效应的文献受到研究设计不完善的限制。考虑到这些设计缺陷，除了可能的溴化物、苯巴比妥和苯二氮䓬类药物外，没有令人信服的证据表明AEDs的认知副作用存在临床上的显著差异。在选择AED治疗时，应正确看待认知副作用的作用。抗惊厥药物的认知副作用可能很明显，但很多时候相当细微。然而，能够识别这些效应并正确看待它们如何影响我们的患者非常重要。
