Cognitive, behavioural and sleep-related adverse effects on introduction of levetiracetam versus oxcarbazepine for epilepsy.
OBJECTIVE
There is limited literature on cognitive, behaviour and sleep-related adverse effects of levetiracetam and oxcarbazepine among adult epilepsy patients, except for what is available from the initial efficacy trials. This study was initiated with the aim to evaluate the incidence and prevalence of various cognitive, behaviour and sleep-related adverse effects of levetiracetam versus oxcarbazepine among people with epilepsy.


METHODS
The study was conducted in two parts: part A was a cross-sectional study, and part B was a longitudinal study. Trail making test A & B, digit symbol substitution test, Stroop colour and word test, controlled oral word association test and PGI memory scale, Neuropsychiatric Inventory, sleep log and ESS-I were used for assessment of cognitive, behaviour and sleep-related adverse effects.


RESULTS
In the cross-sectional as well as prospective study, no significant difference was observed in the cognitive performance of patients in levetiracetam and oxcarbazepine group in any of the cognitive assessment. Among 120 patients enrolled in the cross-sectional study, significantly higher number of patients in the levetiracetam group compared to the oxcarbazepine group,had agitation/aggression (20% vs10%, p =  0.047) and irritability (26.7% vs 3.3%, p = 0.007).Among 132 patients enrolled in the prospective study, significantly higher increase in the domain score of agitation/aggression (14.5% vs 1.6%, p = 0.028) and irritability (17.7% vs 1.6%, p =  0.018) was observed in the levetiracetam group compared to oxcarbazepine group. A significantly higher proportion of patients in the oxcarbazepine group had hypersomnolence (11.3% vs 1.6%, p =  0.026), as compared to the levetiracetam group.


SIGNIFICANCE
On cross-sectional as well as on longitudinal assessment, nearly one-fifth of patients on levetiracetam have behaviour related adverse effects, with dose modification required for half among these. Nearly 11% of patients on oxcarbazepine reported sleep-related adverse effects (higher total sleep duration per 24 h).
['Thelengana|A|A|', 'Shukla|Garima|G|', 'Srivastava|Achal|A|', 'Singh|Mamta Bhushan|MB|', 'Gupta|Anupama|A|', 'Rajan|Roopa|R|', 'Vibha|Deepti|D|', 'Pandit|Awadh Kishor|AK|', 'Prasad|Kameshwar|K|']
D000328:Adult D000927:Anticonvulsants D003072:Cognition Disorders D003430:Cross-Sectional Studies D004827:Epilepsy D005260:Female D006801:Humans D000077287:Levetiracetam D008137:Longitudinal Studies D008297:Male D001523:Mental Disorders D009483:Neuropsychological Tests D000078330:Oxcarbazepine D011569:Psychiatric Status Rating Scales D012893:Sleep Wake Disorders D055815:Young Adult
Cognition Behaviour Levetiracetam Oxcarbazepine Sleep