Since epilepsy is the thing that I have been writing about this semester, I figure I will stick with it. I know I have already addressed some of the adverse effects of the medications used to treat the disorder, but now I am going to delve deeper into the side effects poly (multiple) therapy versus momo (single) therapy. Specifically, how they differ in the side effects. For example, often times the more medications a person takes the greater number or more severe side effects.
Witt, Elger, and Helmstaedter (2015) conducted a retrospective study on the effects of the number of medications patients take as treatment. The cognitive assessment used by all of the studies that they looked at used EpiTrack, which “assesses response inhibition, visuo-motor speed, mental flexibility, visual motor planning, verbal fluency and working memory” (p. 1955). Through the assessment of the data collected from the other studies, it was determined that the number of medication a person takes does tend to increase side effects. The dosage of the medications also have an impact.
My experience with this just happens to be with verbal fluency. As I may have mentioned earlier, I have issues with keeping what I want to type in my mind long enough for me to type it. I also have a great amount of difficulty conversing with people. In my opinion, it is the most frustrating side effect that I have experienced thus far. Actually, just today I told my husband something that he told me that I had already told him yesterday! As Witt, Elger, and Helmstaedter (2015) state, “With regard to the cognitive side effects of antiepileptic pharmacotherapy, the presented data indicate that each additional drug matters” (p. 1959). If I failed to mention this earlier this semester, I am currently on four antiepileptic medications. On a final note, one of the medications was just recently increased, so I am still adjusting to it. I am just hoping I can tolerate it.
References:
Witt, J., Elger, C. E., & Helmstaedter, C. (2015). Adverse effects of antiepileptic pharmacotherapy: Each additional drug matters. European Neuropsychopharmacology, 25, 1954-1959.
Paula,
The side effect findings in that article are not going to be true for everyone who is or has been on the medications that were investigated. I also noticed that the article only mentions polytherapy under one of the medications that that was investigated. However, in my experience, most AEDs have the potential to interact with one another. For example, when the fourth AED was added to my regimen I felt an increase in the side effects that I was already experiencing from the other three. Also, I am not sure if you know this or not, but treatment with medications is, for the most part, a trial and error process. I have been going at this for about 22 years now, and actually have two AEDs on my allergies list because I had such bad reactions to them. However, it was nice of you to suggest the article, and it is informative for people who are new to the medications.
Sorry to hear the effects from the medication that you have to go through. I understand all too well regarding medications and effects on cognition. Different dosages, as well combinations, even changing one, removing one, forgetting one, all impact or can.
I take ADHD medication and have had changes in the type and have experienced verbal fluency issues as well cognition issues from it. As noted in the article, “Treatment with medications affecting dopaminergenic and serotonergic mechanisms: effects on fluency and anxiety in persons who stutter,” it states “serotonin reuptake inhibitor properties, such as clomipramine, have been shown to improve fluency. ” (NCBI, 2016)
I found this article, “Verbal Fluency in Parkinson’s disease patients on/off dopamine medication” to be very interesting: “Parkinson’s disease (PD) is associated with dopamine depletion in the fronto-striatal network which affects some language aspects such as verb processing. Some experiments have demonstrated that dopamine deficiency plays a role in the normal functioning of the lexico-semantic system. As a result, the verbal fluency task could be a useful tool to assess the function of the semantic system, by examining both the number of words generated and the frequency of use of those words.” (Science direct, 2016)
It also stated “off medication produced significantly fewer words in phonological, and actions.” (Science direct, 2016)
Verbal frequency, and functioning of our lexico-semantic system are definitely affected! Processing and cognition are impacted. Medications on/off will change or impact how we do/process, or our fluency.
I do understand repeating something I told my daughter or family as well. I wish you the best and appreciated you sharing this. 🙂
I completely understand what you mean!
I’m also sorry to hear that you are having problems with side effects from your medications. I hope that at least your seizures are well controlled. Polypharmacy is a big problem in America to be sure. There was a study done back in 2008 that tried to address the issue of polypharmacy. They used two common definitions (ie, 6 or more medications or a potentially inappropriate medication) to evaluate polypharmacy in elderly South Carolinians (n = 1027). Data analysis demonstrated that a significant percentage of this population was prescribed six or more concomitant drugs and/or used a potentially inappropriate medication. The findings were 29.4% were prescribed 6 or more concurrent drugs, 15.7% were prescribed one or more potentially inappropriate drugs, and 9.3% met both definitions of polypharmacy used in the study. But what they ended up concluding was that multiple drug use is very common because the elderly population has a higher prevalence of chronic diseases. With epilepsy, especially epilepsy that fails to be controlled with 2 or more medications, the doctors often don’t have much else to offer.
References: Reamer L Bushardt, Emily B Massey, Temple W Simpson, Jane C Ariail, and Kit N Simpson. Clinical Interventions in Aging. 2008 Jun. Retrieved 2016 Dec. From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2546482/
I’m sorry you are having difficulties with the side effects of the medication you are currently taking, specifically having “verbal fluency” issues, to the effect of not remembering something long enough in order to communicate effectively. With that in mind I wanted to learn more about the effects of AED’s on cognition. I read a very interesting journal published on the US National Library of Medicine’s website regarding this topic. I made a summary of the article below, but highly recommend reading it, if you are interested in the specific details of the research methods used. I will list the drugs in order of appearance in the journal.
Phenobarbital and primidone: reported few cognitive adverse effects (non-verbal, mainly in children)
Phenytoin: reported declines in concentration, memory, visuomotor functions, and mental speed (may be dose related)
Carbamazepine: studies reported deterioration in measures of information processing speed and attention. Other studies report poorer verbal fluency in adults with partial seizures.
Sodium valproate and ethosuximide: studies reported that valproate exerts little detrimental impact on cognitive function.
Tiagabine: studies report very few cognitive adverse effects.
Vigabatrin: studies reported few cognitive adverse effects when compared with placebo in double-blind studies.
Clobazam: studies report very few cognitive adverse effects.
Zonisamide: Retrospective analysis showed memory loss in 35% and attentional problems in 27% of 60 patients, while other reports indicate cognitive problems in 4–12% of children. Worse performance was apparent in tasks involving attention, memory and verbal fluency, and was related to dose.
Gabapentin: Most studies tend to report little or no cognitive impairment in association with gabapentin, including double-blind studies.
Pregabalin: In one study, only 4% of patients taking pregabalin reported cognitive problems. When present, possible cognitive adverse effects include deterioration in verbal and visual episodic memory
Topiramate: Studies reported cognitive side effects that can include impaired concentration, cognitive dulling, psychomotor slowing, language and comprehension problems, detrimental effects on short-term memory, working memory, poor verbal fluency, and word-finding deficits, reduced IQ score, cognitive speed, and abnormal thinking.
Lamotrigine: Has been shown to have a favorable cognitive profile in comparison with other AEDs. Verbal fluency and attentional/inhibitory performance is better than with carbamazepine, list learning may be better than with oxcarbazepine, and a double-blind, randomized study of adults with partial seizures showed performance was better with lamotrigine than topiramate for verbal fluency.
Oxcarbazepine: Studies have indicated no deterioration in learning, memory or attention in patients treated with oxcarbazepine, and little evidence of cognitive problems after 4–12 months of treatment.
Levetiracetam: Studies have reported no detrimental effects on cognition.
References: Clare M. Eddy, Hugh E. Rickards, Andrea E. Cavanna.Ther Adv Neurol Disord. 2011 Nov. Retrieved 2016 Nov. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229254/