Details

Autor(en) / Beteiligte

• Perkins, Jon Davis
• Abdelmoneim, Mohamed S.
• Wilkins, Stacy Schantz
• Kamran, Saadat
• Mesraoua, Boulenouar
• Melikyan, Gayane
• Alrabi, Abdulraheem
• El-Bardissy, Ahmed
• Elalamy, Osama
• Al Hail, Hassan Jassim

Titel

Dosage, time, and polytherapy dependent effects of different levetiracetam regimens on cognitive function

Ist Teil von

• Epilepsy & behavior, 2023-11, Vol.148, p.109453-109453, Article 109453

Ort / Verlag

Elsevier Inc

Erscheinungsjahr

2023

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• •At low doses, over short durations, and without multiple concurrent medications, levetiracetam (LEV) is minimally associated with poor cognition.•LEV at high doses, as part of long-term seizure management in conjunction with multiple antiseizure medications (ASMs), is associated with cognitive impairment.•Language, attention, and verbal delayed recall are the most affected cognitive domains in patients receiving high LEV drug loads.•Distinct LEV drug load regimens can yield comparable outcomes in terms of cognitive dysfunction.•Opting for individualized strategies in the management of seizures is recommended as a means of mitigating the adverse cognitive consequences associated with LEV. Regular cognitive screening should be applied to high drug load LEV patients. Cognitive impairment is a potential drawback of antiseizure medications. This study aimed to evaluate the impact of different levetiracetam drug regimens on cognitive function. A retrospective analysis identified 221 patients diagnosed with seizures who underwent cognitive screening. Patients were categorized into four groups: no medications, non-levetiracetam medications, high and low dose levetiracetam. Composite scores determined low and high levetiracetam groups whereby one point was added for each increment in dosage, duration since uptake, and concurrent anti-seizure medication. Variables known to affect cognition were recorded and classified as demographic, seizure-related, diagnosis-related, and psychopathology. Logistic regression was used to identify variables associated with cognitive scores below cut-off. Multivariable analysis found being male, non-active in the community, less than 12 years of education, left temporal lobe epilepsy, high seizure frequency, and depression were associated with poor cognitive performance. In a final regression analysis, the high levetiracetam group exhibited a 4.5-fold higher likelihood of scoring below cut-off than the medication-free group (OR 4.5, CI 1.5–13.6, p<.08). Depression (OR 2.1, CI 1.1-3.9, p<.03), being male (OR 2.2, CI 1.1-4.3, p<.02), and not being active in the community (OR 3.8, 1.6-8.7, p <.003) remained significant contributors to the model. Language (p<.05), attention (p<.05), and delayed recall (p<.001) were the most affected cognitive domains. When taken in small doses, for brief periods as monotherapy, levetiracetam minimally influences cognition. At higher doses, as part of long-term seizure management, in conjunction with multiple ASMs, LEV is associated with cognitive impairment.