Evaluation of cognitive functions in migraineurs treated with topiramate

The assessment of the impact of antiepileptic drugs on cognitive functions via N-200/P-300 potentials and neuropsychological measures

OBJECTIVE

The effects of antiseizure medications (ASMs) on cognitive functions have not been fully elucidated. The primary aim of this study was to demonstrate potential changes in cognitive functions in patients diagnosed with epilepsy from both neuropsychological and electrophysiological perspectives. Our secondary objective was to assess the effects of administered ASM on cognitive functions by categorizing patients into different monotherapy and polytherapy groups.

MATERIALS AND METHODS

A single-center, prospective patient registry study was conducted between May 2022 and June 2023. The inclusion criteria included epilepsy patients aged 18 to 50 years who were receiving ASM) treatment, either as inpatients or outpatients, and who did not have any syndromic diagnosis that may lead to cognitive disfunciton (such as primary progressive myoclonic epilepsies, Down syndrome and so on), and did not diagnosed previously or during examination that could affect dementia or cognitive functions. Patients who were scheduled to initiate new ASM treatment were evaluated using the Montreal Cognitive Assessment (MoCA) scale and Event-Related Potentials (ERP) assessment both before commencing treatment and three months thereafter.

RESULTS

A total of 320 participants were included in the study; 20 healthy controls and 300 epilepsy patients were included. Statistically significant differences were observed between the healthy control group and the epilepsy group in terms of average Montreal Cognitive Assessment (MoCA) scores and event-related potentials (ERPs) (n200, p300 latencies, n2p3 amplitudes) (p<0.05). Similarly, statistically significant differences were observed between the monotherapy and polytherapy groups in terms of average MoCA and ERP scores (p<0.05).

CONCLUSION

This study demonstrated the detrimental effects of certain ASMs, particularly topiramate and carbamazepine, on cognitive functions. Furthermore, the negative impact on cognitive performance became more pronounced with an increasing number of concurrently used ASMs (polytherapy), with topiramate showing notable effects.

Recent Advances in the Management of Cluster Headache

Purpose of review

Among the spectrum of pain conditions, cluster headache represents one of the most severe. Targeted therapies for cluster headache are evolving thus improving the available therapeutic armamentarium. A better understanding of the currently available therapies, as well as new and emerging options, may aide physicians to manage affected sufferers better by evolving treatment guidance.

Recent findings

While classic first-line medications are useful in some patients with cluster headache, they are often accompanied by significant side effects that limit their use. Recently, novel treatments with better tolerability and decreased medication interactions have proven to be effective. A remarkable example of this is the blockage of the calcitonin gene-related peptide pathway with monoclonal antibodies, which may be a key element in the future treatment of cluster headache. The sphenopalatine ganglion and vagus nerve perform a critical role in the regulation of pain and the trigeminal autonomic reflex. Neuromodulation therapies targeting these structures have shown excellent tolerability and few significant adverse events, constituting a promising form of treatment. Finally, several potential therapeutic targets are examined in this review, such as small molecule CGRP receptor antagonists, known as gepants, and serotonin receptor 5-HT1F receptor agonists: ditans.

Summary

In summary, a deepening of the understanding of cluster headache mechanisms in recent years has driven the evolution of sophisticated therapeutic approaches that could allow a new era in the treatment of this difficult condition.

Information Processing in Migraine: A Review of Studies on P300

Subjective cognitive dysfunction is common among migraineurs. The aim of this review is to evaluate the usefulness of psychophysiology by means of the P300 component of the event-related potential in the understanding of subtle and sub-clinical changes in cognition that may occur during and between migraine episodes. Some P300 studies suggest a potential impairment of information processing, as reflected by only few findings of interictal decreased amplitude and prolonged latency, ictal augmented amplitude and prolonged latency, changes in cognitive habituation, and limited capacity to relocate attention away from painful stimuli. P300 may represent a valuable aid for clinicians to identify patients at risk of chronicization and cognitive weakening due to neurovascular complications; in this perspective a research agenda may be planned involving larger numbers of patients undergoing psychophysiological studies.