RESUMO
The respective role of seizures, cerebral lesion, and antiepileptic drugs [AED] on development, cognition and behavior is difficult to identify and despite numerous clinical investigations, this remains questionable. The aim of this research was to assess neurodevelopment in children with newly diagnosed idiopathic generalized tonic-clonic epilepsy before and 6 months after treatment using the most commonly used AED in pediatric population as monotherapy [sodium valproate and carbamazepine] to determine the possibility of cognitive and behavioral effects of these AED. A randomized parallel group study design has been conducted on 40 children with newly diagnosed generalized tonic clonic epilepsy. Their age ranged from 4 to 9 years. All the included children received baseline neurodevelopmental assessment before administration of any AED. Then they were randomly assigned to two groups [20 patients each]. The first group received sodium valproate and the second group received carbamazepine as monotherapy, with follow-up and re-evaluation 6-month after initiation of treatment. Neurodevelopmental assessment of studied children included global developmental assessment using Denver II test, cognitive assessment using Wechsler Intelligence Scales, visual motor assessment using Bender-Gestalt test and behavior assessment using the Pediatric Symptom Checklist. The results showed that there were no significant differences between the valproate and carbamazepine groups on any neurodevelopmental measures neither prior to administration of the study drug nor at 6- month reassessment, except for picture completion score of performance IQ. Within group comparisons, using t-test for related samples determined that valproate group had a significant lowering of full scale IQ on reassessment. Performance IQ scores decreased significantly in both groups at the 6-month reassessment compared to pre-treatment scores in spite of complete control of seizures within the therapeutic dose. The same was observed with Denver I1 test, as the proportion of suspect cases to normal were significantly higher in both groups at 6-month reassessment. Analysis of Pediatric Symptom Checklist results showed that 35% of all patients [5 patients in valproate group and 9 patients in carbamazepine group] had score 2 [problems] before start of any treatment and this was significantly different after 6 months in valproate group only. There was no significant change in Bender-Gestalt score in both groups at 6-month reassessment. Significant relation was observed between lowering in IQ score after treatment and frequent seizures, cases with slow wave and spikes, and generalized epileptiform activity in EEG
Conclusions and Recommendations: the two studied drugs were associated with absolute cognitive and behavioral side effects, although these effects are significantly evident in valproate group. Therefore, the cognitive and behavioral effects of therapies for epilepsy must be an important consideration in the evaluation of risk/benefit ratios directing treatment decisions. Physicians prescribing anticonvulsants should monitor the child behavior, academic progress, cognitive function, and mood, during follow-up visits. Diagnosis of such selective changes early in life is of critical importance, both to provide the affected children with appropriate remedial help in school and in daily life and to protect against the adverse socio-emotional consequences that can impose on the developing child