Reviews / Epilepsy Research 68 (2006) 19–94 63 can achieve these goals using TDM/biomarkers. These steps will assure better drug efficacy and safety with personalized therapeutics for patients with epilepsy. Reference Cramer, J.A., Spilker, B. (Eds.), 1991. Patient Compliance in Medical Practice and Clinical Trials. Raven Press, New York. Johannessen, S.I., Battino, D., Berry, D.J., Bialer, M., Kramer, G., Tomson, T., Patsalos, P.N., 2003. Therapeutic drug monitoring of the newer antiepileptic drugs. Ther. Drug Monit. 25, 347–364. Leppik, I.E., 2001. Contemporary Diagnosis and Management of the Patient with Epilepsy, fifth ed. Handbooks in Healthcare, Newborn, PA. Levy, R.H., Mattson, R.H., Meldrum, B.S., Bashir, K.H., Perucca, E. (Eds.), 2001. Antiepileptic Drugs, fifth ed. Lippincott Williams & Wilkins, Philadelphia. Pippenger, C.E., 1979a. Editorial-therapeutic drug monitoring. Ther. Drug Monit. 1, 1–2. Pippenger, C.E., 1979b. Therapeutic drug monitoring: an overview. Ther. Drug Monit. 1, 3–9. doi:10.1016/j.eplepsyres.2005.09.022 COGNITIVE AND BEHAVIORAL EFFECTS OF AEDs Antiepileptic drugs may impact the CNS in beneficial or negative ways. The beneficial effect on mood have been exploited as additional indications for mood sta- bilization. It is equally as important to monitor for adverse effects on mood and cognition. Dr Meador reviews available data on cognitive effects of the new antiepileptic drugs. Dr. Gilliam discusses the relative advantages and disadvantages of different methods that have or could be used to study mood effects. Cognitive and memory effects of the new antiepilep- tic drugs Kimford J. Meador Abstract Problems with cognition are common in patients with epilepsy. A series of double-blind, randomized, crossover, healthy volunteer studies have been con- ducted to avoid a variety of the confounding effects on cognition such as those produced by changes in seizure frequency. All of the older AEDs produced cognitive effects compared to the non-drug conditions. The cog- nitive effects of several of the new AEDs are described although data are limited. Studies have demonstrated that in utero AED exposure in humans may affect cog- nitive development. Although the cognitive effects of AEDs are generally modest, these effects can have clin- ical significance. The available data suggest that some of the new AEDs have fewer effects on cognition and memory than the older AEDs, and these differences can have clinical impact. Contents 1. Introduction ........................... 63 2. Cognitive effects of new AEDs .......... 64 2.1. Gabapentin ...................... 64 2.2. Lamotrigine ..................... 64 2.3. Oxcarbazepine ................... 64 2.4. Carbamazepine, levetiracetam, and oxcarbazepine ................... 65 2.5. Tiagabine ........................ 65 2.6. Topiramate ...................... 65 2.6.1. Topiramate and valproate . . 65 2.6.2. Topiramate and gabapentin 65 2.6.3. Topiramate and lamotrigine 65 3. Relative effects of AEDs on memory ..... 65 4. Effects of in utero AEDs on behavioral neurodevelopment ...................... 65 5. Import of AED neuropsychological effects 66 6. Summary .............................. 66 References ............................ 66 1. Introduction Problems with cognition are common in patients with epilepsy. A recent survey by the International Bureau for Epilepsy revealed that 44% of patients with epilepsy complained of difficulty learning, 45% felt that they were slow thinkers, 59% felt sleepy or tired, and 63% antiepileptic drug (AED) effects prevented them from achieving activities or goals (Cognitive Function Survey, 2004). As listed in Table 1, multiple factors may affect cognition and memory in patients with epilepsy. AEDs are an important factor for clini- cians to consider because AEDs are the main treatment