**7. Psychological side effects in children**

There is evidence that both topiramate and levetiracetam can lead to undesirable mood changes, particularly depression, irritability, personality changes, and hyperactivity in some children. Phenobarbital and primidone can lead to behavioral problems in children as well. Lamotrigine, on the other hand, has a mood-enhancing effect in children like in adults [29], and in children also has a positive effect on aggressiveness and impulsiveness [15]. Rufinamide appears to be unproblematic with regard to undesirable psychological disturbances [30].

In children and adolescents with intellectual disabilities, an increase in behavioral problems has occasionally been described with lamotrigine. Here, however, this might be due to the "lack of" sedation under lamotrigine compared to other anticonvulsants and the possible associated improved vigilance. If the medication switch to lamotrigine leads to behavioral problems, this might not be related to the medication

but to the possibly underlying disease and then of course it requires another handling than that of a re-sedation.

In summary, it is advisable to check a possible relationship between a newly dosed anticonvulsant and the psychological complaints of a patient and then to counteract this by switching to an alternative medication. Since correlations between emotional side effects of anticonvulsants, a rapid dose escalation, an already existing mental illness and a family predisposition for mental illness were found, it is advisable to consider these aspects in drug selection [31].

## **8. Control of possible psychological side effects**

To control possible psychological side effects, questionnaires can be used in addition to exploration and behavioral observation. The Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI) and the Hospital Anxiety and Depression Scale (HADS) are well-known and well established methods [32–34]. The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) was developed specifically for people with epilepsy to detect depressive symptoms [35]. For children, the Child Behavior Checklist (CBCL-4-18) is recommended [36].

#### **9. Alternatives to drug therapy**

Due to the diverse side effects of anticonvulsants, alternative treatment methods (e.g. epilepsy surgery) should be considered early if therapy refractivity is determined. Therapy-refractory epilepsy is present if two suitable anticonvulsants dosed up to the interference limit in monotherapy and a combination therapy has not led to seizure freedom. For a clearly defined group of patients, epilepsy surgery is a safe, wellestablished and very promising treatment option: For example, in the case of unifocal temporal lobe epilepsy due to proven hippocampal sclerosis, the chance of postoperative freedom from seizures is up to 80%. In comparison, the chances of success of a further drug change for these patients are significantly lower.

### **10. Conclusion for practice**

Since drug-based epilepsy therapy is mostly a long-term – sometimes a lifelong – therapy, it is of particular importance to take undesirable interfering effects into account. In addition to the frequency of seizures, cognitive and psychological side effects are particularly serious for the quality of life of patients. Therefore, when treating epilepsy with drugs, the focus should not only be on the desired effects on the frequency and severity of seizures, but also on possible undesirable effects on cognitive performance and mental health. Both the individual living conditions of the individual patient (e.g. possible later desire for children, upcoming training/ studies) as well as possible comorbidities (e.g. previous psychological comorbidity, intellectual impairment, cognitive partial performance disorders) must be taken into account when selecting drug therapy. Especially in children, patients with intellectual disabilities and elderly patients (due to the increased vulnerability to undesirable disturbances), it is recommended to start with a low dose and slowly increase the dose ("start low, go slow"). For certain substances, the monitoring of cognitive functions and mood before and during the change/adjustment is necessary, e.g. based on neuropsychological follow-up examinations, special screening procedures and a detailed and specific questioning of the patient and the caregivers (**Table 1**).


#### *Cognitive and Psychological Side Effects of Antiepileptic Drugs DOI: http://dx.doi.org/10.5772/intechopen.94308*

**Table 1.**

*Overview of possible cognitive and psychological side effects of anticonvulsants.*
