| Summary: | Objective: There is evidence that in patients with epilepsy interictal discharges can be accompanied by transitory cognitive impairment (TCI). However, it is not kno\vn whether interictal discharges and TCI impair day to day psychosocial functioning, and if so whether drug treatment to suppress discharges is effective in the absence of clinical seizures. Aims of study: (1) Effect of lamotrigine on interictal discharges, behaviour and cognition in children with epilepsy. (2) Effect of interictal discharges on behaviour and cognition in children with epilepsy. (3) Effect of suppression of discharges behaviour in children with epilepsy. Method: In a randomised, double-blind, placebo-controlled, cross-over study with lamotrigine ambulatory EEG, cognitive test battery and behavioural scores were measured in 61 patients at baseline, placebo and lamotrigine phase. Results: Interictal discharges are common in children with epilepsy even if seizures are well controlled. Lamotrigine reduced the duration of discharges per hour, but not the total number per hour in this group of patients. Lamotrigine had no significant negative or positive effect on cognitive performance in children with epilepsy. Tel was found in over 500/0 of patients with sufficient discharges for analysis. There was a significant correlation of side of discharges to the type of test (spatial or verbal), when correcting for dominant hemisphere. Interictal discharges were associated with impaired cognitive performance (working memory). During treatment with lamotrigine global rating of behaviour significantly improved in patients with a reduction in discharges rate, but not in patients with without a change in discharge rate. This was independent of randomization or presence of seizures. Conclusion: lnterictal discharges are common even in children with well-controlled epilepsy and associated with cognitive impairment particularly affecting \\orking memory. Our data suggest that suppressing interictal discharges can improve behaviour in children with behavioural problems and epilepsy.
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