Antiepileptic drugs
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Cognitive function impairment and drug ineffectiveness: case report An approximately 4-year-old girl developed cognitive function impairment during antiepileptic treatment with topiramate and zonisamide. Additionally, she exhibited drug ineffectiveness while being treated with topiramate, zonisamide, carbamazepine, sodium valproate, levetiracetam, lamotrigine and clobazam [routes not stated; not all dosages stated]. The girl was diagnosed with focal epilepsy at the age of 3 years and 8 months. She started receiving antiepileptic therapy with topiramate and zonisamide, along with carbamazepine, sodium valproate, levetiracetam, lamotrigine and clobazam. Prior to the onset of seizures, her psychomotor development was normal, and she able to speak a number of meaningful words in short sentences. However, within 6 months of seizure onset, developmental regression (cognitive function impairment) became apparent, and she was able to only express simple monosyllabic words. Her antiepileptic drugs were found to be ineffective at controlling seizures. Thus, at the age of 4 years and 10 months, she was hospitalised, and underwent a right frontal lobectomy. Her overall developmental quotient (DQ) prior to surgery was 35, and her score in the language-social ability category was 36. At the period of time when testing occurred, she was receiving topiramate 90 mg/day. Although a seizure was noted on the day after the surgery, none were noted subsequently. At 3–5 days post the surgery, the girl was able to speak several meaningful words, which she had been unable to do in the months prior the surgery. An MRI scan performed 1 year after surgery and the resected lesion was sent for further investigation and was histopathologically confirmed to be ganglioglioma. One year following the surgery, her overall DQ increased by 24 points to 59, and her score in the language social ability category increased by 22 points to 57. Therapy with topiramate was maintained after the surgery. Her acute improvement of verbal function was then viewed as a quick developmental recovery, rather than as developmental progress. However, it remained unclear whether her cognitive function eventually reach the normal range. It was concluded that she had epileptic encephalopathy because her cognitive function was impaired by epileptic activity and subsequently recovered following the detrimental effects of epileptic activity were reduced. It was also considered that the antiepileptic drugs including topiramate and zonisamide might have contributed to impairment of cognitive function. Yoshitomi S, et al. Verbal function recovery in a postoperative case with epileptic encephalopathy. Pediatrics International 62: 412-414, No. 3, Mar 2020. Available from: 803504307 URL: http://doi.org/10.1111/ped.14087
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Reactions 3 Oct 2020 No. 1824
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