الفهرس 
Introduction
Definition Of EpilepsyOnly 14 pages are availabe for public view
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Abstract
Epilepsy is a chronic neurological disorder characterized by recurrent episodes of sensory, motor or autonomic phenomena with or without loss of consciousness. PWE face many psychosocial challenges (anxiety, social stigmaand unemployment) that can negatively impact QOL. Such growing recognition of the importance of the psychosocial effects of epilepsy has led to the need to quantify QOL in affected individuals. Hence, appropriate AEDs use, along with monitoring of adverse effects, and assessment of QOL as an outcome measure are important in the management of epilepsy to achieve optimal seizure control. Also, many PWE report impairments in their cognitive functioning. The main contributing factors to cognitive dysfunction in PWE are the side effects of AEDs, the underlying etiology of their epilepsy, psychosocial issues, and the effects of recurrent seizures.
36 newly diagnosed epileptic patients were recruited from outpatient clinic Assiut University Hospital which considered the largest and highly qualified tertiary care center in Upper Egypt during the period from 1st of March 2014 till the 31st of December 2015. All patients fulfilled the inclusion criteria: (1) Any epileptic patients aged >15 years old, (2) Newly diagnosed epileptic patients and (3) Idiopathic generalized tonic colonic type and Exclusions criteria: (1) Other type of epilepsy, (2) Any metabolic or systemic causes associated with cognitive consequences or sign suggest cognitive dysfunction and (3) Any previous or coincident neurological insult causing cognitive impairment or epilepsy associated with psychiatric manifestations.
This present study is aimed to study the effect of monotherapy of AEDs (LTG, CBZ and VPA) in cognitive function and QOL of in newly 36 diagnosed patients with idiopathic generalized epilepsy( were recruited from out patients clinics of epilepsy) according to ILEA classification and definition.
Each epileptic patients are subjected to the following; systemic and neurological examination, standardized neurological sheet designed for epilepsy, QOLIE-31; MMSE, WAIS- IQ, MAS, and ERPS) at baseline line before treatment and drug assay.
Patients were classified into 3 groups randomly 1:1:1 to AED treatment ; (CBZ, VPA, and LTG) . As 12 patients for each group and dose prescribed with gradual standardizing dosing for each group.
On follow up the measurement that done at baseline , assessed 1 and 3 months after treatment; neuropsychological assessment (QOLIE-31; MMSE, WAIS- IQ, MAS, and ERPS) and AED assessment of serum level.
There was no significant difference between demographic and clinical variables of 3 AED groups for epilepsy pattern and scores of clinical rating scales(QOLIE-31, MMSE,IQ WAIS-IQ, MAS) and ERPs measurements.
The main results of this study showed ADEs monotherapy improve QOl of newly diagnosed epileptic patients and LTG monotherapy was significantly more effective than VPA and CBZ monotherapy in improving several aspects of QOL in newly diagnosed epileptics patients after three months of treatment. Also, we conclude that LTG offers the newly diagnosed patient with generalized tonic clonic seizures significant benefits of greater tolerability. Whereas, frequency of seizures was the most important factor influencing QOL in new epileptic patients.
The results of the current study provide additional information on the cognitive effects of AED, which may be of assistance to physicians and their patients in making treatment decisions. We concluded that CBZ monotherapy has adverse cognitive effect in new epileptic patients assessed by MAS (P-values of short term, verbal and global memory of MAS along the course of treatment and follow up in CBZ group 0.049, 0.001 and 0.003 respectively) in comparison to LTG and VPA monotherapy after three months of treatment while no significant change in cognition when WAIS was used.
Also we concluded that CBZ monotherapy has an effect on P300 latency in new epileptics patients after three months of treatment, in comparison to VPA and LTG monotherapy which have no effect. P300 has been widely used for investigating the cognitive functions and is thought to reflect the neurophysiological activities related to cognitive processes, such as attention, discrimination and working memory.
The study had two major limitations.
First, we did not include normal controls for comparison. The lack of a healthy control groupwould have been valuable not only in identifying subtle cognitiveproblems at onset but also in controlling for test–retest practiceeffects on the cognitive measures. However, as well as our mainresearch focus was to outline the cognitive profile of patients withnewly diagnosed epilepsy and detect any possible changes afterthe start of drug treatment.
Second, the small sample size prevents usfrom drawing firm conclusions, as many differences perhaps failed to attain statistical significance.
Recommendation
1. Additional studies are needed to establish the neuropsychological effects of the other newer AEDs on long term and to compare the relative effects of the newer AEDs with each other.
2. Also, studies are needed to use large size of population.