Muristek
In Reply In response to our recent Review of antiseizure medications for adults with epilepsy, Drs Maggiani and Bo mention the risk of iatrogenic cognitive disturbances caused by several antiseizure medications with anticholinergic properties, particularly in older adults. They suggest that the anticholinergic effects of these drugs (such as carbamazepine, oxcarbazepine, and valproic acid) may account for cognitive disturbances. It is well known that older adults are more susceptible to iatrogenic cognitive effects even at doses that are therapeutic in younger people. The mechanisms for these adverse events are multifactorial, and we cannot exclude the possibility that the anticholinergic effect of some of the antiseizure medications could be one of the operant pathogenic mechanisms. However, after receiving this Letter, we performed a medical literature search and were unable to identify a single clinical study that reported a direct association between cognitive adverse events and anticholinergic effects in patients with epilepsy taking carbamazepine, oxcarbazepine, or valproic acid. Given this lack of data, the hypothesis of iatrogenic adverse cognitive effects arising from the anticholinergic properties of these drugs remains a theoretical concept that merits careful investigation in future clinical studies.
Most Read