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The Cognitive Profile of Ethosuximide in Children

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Abstract

Introduction

Although ethosuximide is one of the oldest antiepileptic drugs (AEDs), little information is available about the cognitive side effects of ethosuximide.

Objective

The aim of this study was to investigate the cognitive profile of ethosuximide.

Methods

In this cross-sectional study, we used an extensive neuropsychological test battery in patients with epilepsy aged 6–16 years who were treated with monotherapy ethosuximide. We evaluated the efficacy of the drug by seizure frequency (seizure free or not).

Results

We included 61 patients with a mean age of 9.4 years [standard deviation (SD) 2.7] who used on average 686 mg/day (SD 245) ESM as monotherapy. ESM was effective in the majority of the patients (70 % were seizure free for at least 6 months at moment of inclusion). The total study population showed impairments of intelligence, visuomotor, and attentional function including activation/alertness. Comparisons between the well-controlled patients and patients who were not in remission showed significantly lower intelligence values and lower performance on the visual-perceptual and attentional tasks for the group with ongoing seizures. Our results suggested that the higher order cognitive dysfunctions (such as intelligence and visual-perceptual functions) may be regarded as seizure or aetiology effects and that the impaired fluid cognitive functions, such as activation/alertness, sustained auditory attention and attentional control or switching, were due to ESM.

Conclusion

This study suggests the attentional dysfunction resulting in psychomotor slowing and alertness deficits may be regarded as effects of ethosuximide. Although no untreated baseline assessment was available, these effects are comparable to those of other AEDs, and ethosuximide may therefore be considered an AED with only mild effects on cognition. As ethosuximide is a first-line therapy for absence seizures in childhood, and drug-induced cognitive impairment may interfere with development, learning, and academic achievement, these findings are of interest to clinicians who prescribe this drug, especially when informing parents.

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Author information

Authors and Affiliations

  1. Department of Behavioural Sciences, Epilepsy Centre Kempenhaeghe, P.O. Box: 61, 5590 A.B., Heeze, The Netherlands

    Dominique M. IJff & Albert P. Aldenkamp

  2. School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands

    Dominique M. IJff, Tamar M. van Veenendaal, Jacobus F. A. Jansen, Marian H. J. M. Majoie & Albert P. Aldenkamp

  3. Departments of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands

    Tamar M. van Veenendaal & Jacobus F. A. Jansen

  4. Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands

    Mariette H. Debeij-van Hall, Anton J. A. de Louw & Marian H. J. M. Majoie

  5. Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands

    Anton J. A. de Louw, Marian H. J. M. Majoie & Albert P. Aldenkamp

  6. Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands

    Anton J. A. de Louw & Albert P. Aldenkamp

  7. Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands

    Marian H. J. M. Majoie

  8. Department of Neurology, Ghent University Hospital, Ghent, Belgium

    Albert P. Aldenkamp

Authors
  1. Dominique M. IJff
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  2. Tamar M. van Veenendaal
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  3. Mariette H. Debeij-van Hall
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  4. Jacobus F. A. Jansen
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  5. Anton J. A. de Louw
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  6. Marian H. J. M. Majoie
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  7. Albert P. Aldenkamp
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Corresponding author

Correspondence to Dominique M. IJff.

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Conflict of interest

Dominique M. IJff, Tamar M. van Veenendaal, Mariette H. Debeij-van Hall, Jacobus F.A. Jansen, Anton J.A. de Louw, Marian H.J.M. Majoie, and Albert P. Aldenkamp have no conflicts of interest.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Formal consent is not required for this type of study (retrospective).

Informed consent

Every patient referred to our tertiary referral center is asked to give permission for their data to be used for research. Informed consent was obtained from all individual participants included in the study.

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IJff, D.M., van Veenendaal, T.M., Debeij-van Hall, M.H. et al. The Cognitive Profile of Ethosuximide in Children. Pediatr Drugs 18, 379–385 (2016). https://doi.org/10.1007/s40272-016-0187-z

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  • DOI: https://doi.org/10.1007/s40272-016-0187-z

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