B – 12 The Mediating Cognitive Effects of ASMs in Pediatric Focal Epilepsy

Abstract Objective This systematic review seeks to explore the mediating cognitive effects of antiseizure medications (ASMs) on children with focal epilepsies. Method A systematic review following PRISMA guidelines was conducted via PubMed and Google Scholar, applying consistent strategies across databases. Keywords included "pediatric," "focal epilepsy," "antiseizure medications," "cognitive impairment," and "neuropsychology," filtered for human studies in English from January 2015 to January 2025. From the initial 603 results, the final set included 23 studies after filtering for inclusion and exclusion criteria. Results Higher ASM exposure was linked to greater executive dysfunction and lower IQ, suggesting a cumulative drug load with polytherapy. Perampanel and eslicarbazepine showed minimal cognitive effects, while topiramate impaired memory, attention, processing speed, and verbal fluency. Oxcarbazepine and lamotrigine appeared to preserve or improve cognition. Carbamazepine had mixed but mostly neutral effects; levetiracetam preserved cognition but caused behavioral issues. Valproate impaired memory, attention, and processing speed. Zonisamide, gabapentin, lacosamide, and phenobarbital were associated with cognitive and behavioral side effects. Conclusion Newer ASMs generally show more favorable cognitive profiles, while older ASMs are more consistently linked to cognitive impairments, particularly in memory, attention, and executive functioning. Higher medication loads and polytherapy further increase cognitive risk. Neuropsychological test findings must be interpreted within the context of ASM effects, particularly for children on polytherapy or high medication loads. These findings highlight the need to prioritize newer, better-tolerated ASMs to balance seizure control with cognitive preservation.