COGNITIVE AND BEHAVIORAL EFFECTS OF LONG TERM ANTIEPILEPTIC DRUG USE IN ADOLESCENTS WITH GENERALIZED EPILEPSY

Background: Adolescents with generalized epilepsy often require long-term antiepileptic drug (AED) therapy during a critical phase of cognitive and emotional development. While AEDs are essential for seizure control, increasing evidence suggests they may adversely affect cognition and behavior, raising concerns about their broader impact on quality of life and neurodevelopment. Objective: This narrative review aims to explore and synthesize current evidence on the cognitive and behavioral consequences of prolonged AED use in adolescents with generalized epilepsy, highlighting differences among commonly prescribed medications and identifying areas in need of further investigation. Main Discussion Points: The review discusses cognitive impairments associated with older AEDs such as valproate and carbamazepine, which are more pronounced compared to newer agents like levetiracetam and oxcarbazepine. Behavioral issues, including emotional instability and attention deficits, are also prevalent. Themes such as treatment duration, monotherapy versus polytherapy, variability in neuropsychological assessments, and methodological gaps in the literature are critically analyzed. Emerging therapies and the need for routine cognitive monitoring are highlighted. Conclusion: The existing literature supports a cautious, individualized approach to AED therapy in adolescents, with attention to neurocognitive outcomes alongside seizure control. Further pediatric-focused, long-term research is essential to guide safer clinical practices and informed policy development.