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All models addressing the etiology of cognitive abnormality in epilepsy include the iatrogenic effects of antiepileptic drugs (AEDs). This interest sustained through the decades began with bromides and phenobarbital1,2 and continues to the present.3 Critical contributions to this literature have included cognitive results from randomized clinical trials of initial and adjuvant therapy, controlled crossover trials in healthy volunteers, dose ranging studies, and numerous clinical investigations examining the cognitive effects of drug add-on or withdrawal. Further evidence of neuronal effects of AEDs that may affect cognition include reports demonstrating AED influences on brain metabolism,4 brain structure,5 brain neurophysiology,6 and functional activation during cognitive tasks.7,8
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