Relative influences of adjunctive topiramate and adjunctive lamotrigine on scanning and the effective field of view

• Published in: Epilepsy research Vol. 78; no. 2; pp. 140 - 146
• Main Authors: Mills, Kenneth C, Drazkowski, Joseph F, Hammer, Anne E, Caldwell, Paul T, Kustra, Robert P, Blum, David E
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.02.2008; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anticonvulsants - adverse effects; Anticonvulsants - therapeutic use; Anticonvulsants. Antiepileptics. Antiparkinson agents; Biological and medical sciences; Cognition - drug effects; Data Interpretation, Statistical; Double-Blind Method; Driving skills; Drug Therapy, Combination; Effective field of view; Epilepsy; Epilepsy - complications; Epilepsy - drug therapy; Female; Fructose - adverse effects; Fructose - analogs & derivatives; Fructose - therapeutic use; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Lamotrigine; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Neuropharmacology; Neuropsychological Tests; Pharmacology. Drug treatments; Seizures - drug therapy; Seizures - epidemiology; Topiramate; Triazines - adverse effects; Triazines - therapeutic use; Vision Disorders - chemically induced; Vision Disorders - psychology; Visual Fields - drug effects; Visual Perception - drug effects; Driving skills; Effective field of view; Topiramate; Epilepsy; Lamotrigine; Nervous system diseases; Scanning; Triazine derivatives; Central nervous system disease; Anticonvulsant; Cerebral disorder
• ISSN: 0920-1211; 1872-6844
• DOI: 10.1016/j.eplepsyres.2007.10.013

Summary A subsample of 67 adult patients with partial seizures participating in a randomized, double-blind study comparing the cognitive effects of adjunctive lamotrigine (LTG) and adjunctive topiramate (TPM) was administered Performance On-Line (POL) in addition to a battery of neuropsychological tests at baseline, week 8 and week 16 of treatment. The POL is a self-administered computer task that measures scanning, divided-attention, and the effective field of view. Although the POL does not measure driving performance, POL scores are correlated with driving performance. The results show that adjunctive TPM, but not adjunctive LTG, negatively impacted cognition. Both simple target identification and divided-attention performance on POL were compromised in the TPM group but not in the LTG group. The relative POL impairment associated with chronic TPM treatment was similar to that observed with the acute effects of alcohol with a breath level of .045% or a low dose of alprazolam (0.5 mg). Thus, driving-related visual and cognitive skills were compromised by adjunctive TPM treatment. Therapeutic doses of adjunctive TPM pose a potential risk of impaired scanning and divided-attention skills.