Cognitive outcome of antiepileptic treatment with levetiracetam versus carbamazepine monotherapy: A non-interventional surveillance trial

This open-label, non-interventional, controlled surveillance study evaluated the cognitive outcome of patients administered levetiracetam (LEV) or carbamazepine (CBZ) monotherapy as primary treatment or as substitution for previous treatment. Executive functions, verbal memory, and subjective ratings were assessed before and 6 months after initiation of LEV or CBZ monotherapy. Analyses included 498 patients: 370 received LEV (63% pretreated), and 128 CBZ (34% pretreated). Mostly because of the substitution condition, the seizure freedom rate was slightly higher with LEV as opposed to CBZ (78% vs 69%). Almost all cognitive measures improved with LEV but not with CBZ, and repeated-measures MANOVA did not indicate seizure control or pretreatment as decisive with respect to cognitive change. With LEV, executive functions improved in 15% and deteriorated in 5% of patients; the opposite pattern was seen under CBZ (improvement with LEV OR = 2.3, deterioration with CBZ OR = 3.4). The findings suggest a mild but definitely superior cognitive outcome with LEV as opposed to CBZ monotherapy.