The impact of certain anti-seizure medications on cognitive status, behavior, anxiety, and depression in school-aged children with newly diagnosed epilepsy – a six-month follow-up study

Abstract

Introduction/Objective Previously, we have shown that six months after initiating monotherapy in school-age children with new-onset uncomplicated epilepsy, minimal changes in cognition and significant symptoms of anxiety, depression, and behavioral changes were observed. In the same group of children, we aimed to show and compare the effects of the most commonly used anti-seizure medications (ASMs) on cognition, psychopathological symptoms, and behavior, to provide guidance in selecting appropriate ASMs. Methods Children with newly diagnosed epilepsy completed the Revised Wechsler Intelligence Scale for Children in Serbian (REVISK), the Revised Child Anxiety and Depression Scale (RCADS), and the Nisonger Child Behavior Rating Form (NCBRF), immediately after initiating therapy and six months later, at the University Children’s Clinic in Belgrade. Results Scores on the social phobia subscale increased significantly in children on lamotrigine monotherapy compared to other ASMs, as well as on the separation anxiety disorder subscale and total internalizing symptoms in patients on ethosuximide (p < 0.05). The scores on the depressive disorder subscale increased significantly in those on ethosuximide, followed by levetiracetam (p < 0.05). There is no statistically significant difference in the change of other RCADS scores and REVISK and NCBRF scores between different types of ASMs during the six months (p < 0.05). Conclusion The subtle influence of the tested ASMs was already present during the first six months of treatment. Valproate led to a trend of improved cognition, while ethosuximide and levetiracetam contributed to worsening internalizing symptoms during the first six months. © 2025, Serbia Medical Society. All rights reserved.