Abstracts

There is a wealth of evidence to suggest that people with epilepsy, when compared to normal controls, are much more likely to experience a range of neuropsychological impairments. There are a number of factor that have been linked to the causation of these effects including the underlying lesion, the effects of continuous seizures, the sedative effects of AED treatment and the impact of mood. Determining the relative contributions of these various factors has been difficult but previous studies have confirmed cognitive side effects of several antiepileptic drugs such as central slowing, motor slowing and impairment of attention and concentration. The SANAD trial, a randomised controlled clinical trial of standard versus novel antiepileptic drug treatment, represents a unique opportunity to study the natural history of cognitive impairment in patients with newly diagnosed epilepsy who havge yet to be exposed to AED treatment and who have expereinced few seizures. A standardised battery of neuropsychological tests including measures of psychomotor speed, attention, memory, mental flexibility, tracking tasks, higher executive functioning, mood and patient perceived cognitive effects were administered prior to AED treatment, 3 months and 12 months. There were differences between the epilepsy group and published control data for a number of key domains including: immediate, delayed and recognition memory; new learning; tests of higher executive functioning; sustained attention; and motor speed. These differences were significant at p = 0.001 level. In addition patients also had significantly worse profiles on the profile of mood scale. These results highlight that newly diagnosed patients with epilepsy are already significantly compromised in terms of their neuropsychological and psychological functioning prior to starting AED treatment and exposure to a significant number of seizures. This study will provide and opportunity to study the development of these cognitive effects allowing for treatment and seizure history. It will also allow for the identification of individuals most at risk of developing signficant cognitive difficulties. (Supported by the following pharmaceutical companies: GlaxoSmithKline, Novatis, Jansen Cilag and Sanofi Synthelabo.)