Different cognitive effects of inducing levetiracetam or topiramate into an antiepileptic pharmacotherapy in patients with therapy refractory epilepsy.

Many patients with refractory epilepsy do not experience any considerable improvement in seizure frequency when being treated with an additional antiepileptic drug. Therefore other aspects of quality of life in those patients have to be taken into consideration as well when deciding to change the antiepileptic medication. In this retrospective study we compared the cognitive consequences of the introduction of levetiracetam or topiramate into an antiepileptic polytherapy. Neuropsychological data, seizure severity and frequency and comedication were analysed in 27 patients newly exposed to levetiracetam and 12 patients newly exposed to topiramate during an inpatient treatment on a specialized epilepsy ward. We found that when comedication is reduced as far as possible the introduction of levetiracetam or topiramate into an antiepileptic polytherapy is associated with only minor cognitive changes. Comparing these minor changes there is a significant better development in the performance of a digit span task and the estimation for fluid intelligence in the group of patients newly exposed to levetiracetam.