Uboczne skutki poznawcze leków przeciwpadaczkowych u dorosłych pacjentów z epilepsją: przegląd aktualny ze szczególnym uwzględnieniem nowych leków
Cognitive Side Effects of Antiseizure Medications in Adults with Epilepsy: An Update with a Focus on New Therapeutic Agents
W skrócie
Leki przeciwpadaczkowe są podstawowym leczeniem epilepsji, ale mogą wpływać na zdolności poznawcze pacjenta, takie jak uwaga, pamięć czy szybkość myślenia. Badanie pokazuje, że nowsze leki przeciwpadaczkowe (rufinamid, lakosamid, briwarak, kannabidiol i inne) wykazują mniejsze problemy z poznaniem w porównaniu ze starszymi lekami, zwłaszcza jeśli stosuje się je w pojedynczej dawce lub ostrożnie łączy kilka leków. Lekarz powinien dobierać leki indywidualnie dla każdego pacjenta, aby osiągnąć jak najlepszą kontrolę padaczki bez uszczerbku dla pamięci i myślenia.
Oryginalny abstract (angielski)
Antiseizure medications (ASMs) are the mainstay of epilepsy treatment but may adversely affect cognitive functions, deepening the cognitive and psychosocial burden intrinsic to epilepsy. Cognitive side effects vary widely across drug classes, doses, treatment regimens, and individual susceptibility, typically affecting attention, processing speed, memory, language, and executive function. This narrative review provides an updated synthesis of the clinical evidence on the cognitive effects of ASMs, mostly in adults, building on a prior 2009 review and focusing on agents introduced into clinical practice since then. A literature search of PubMed identified studies published between January 2009 and December 2025, yielding data from randomised controlled trials, observational studies, meta-analyses, and systematic reviews. Overall, newer-generation ASMs, including rufinamide, lacosamide, brivaracetam, cannabidiol, fenfluramine, and ganaxolone, demonstrate generally favourable cognitive profiles when used at recommended doses, particularly in monotherapy or rational polytherapy. Eslicarbazepine and cenobamate may be associated with mild, dose-dependent cognitive effects, occurring only at the upper end of the recommended dose range. In contrast, old ASMs and certain second-generation agents, notably topiramate and zonisamide, remain consistently associated with higher cognitive risks. Special populations, including older adults and individuals with intellectual disabilities, are particularly vulnerable to cognitive adverse effects and benefit from agents with low interaction potential and benign neuropsychological profiles. Cognitive dysfunction in epilepsy is multifactorial, reflecting the interaction between disease-related neurobiological mechanisms and treatment effects. Optimal management requires balancing seizure control with cognitive preservation through individualised drug selection, cautious titration, and minimisation of polytherapy to achieve the best functional and quality-of-life outcomes.