Abstract
OBJECTIVE: Cognitive impairment is a common comorbidity in epilepsy, negatively affecting patients' quality of life. Although various treatments-antiepileptic drugs (AEDs), vagus nerve stimulation (VNS), and surgery-may influence cognition, comparative data on their effects on executive functions and memory remain limited. This systematic review aimed to evaluate studies assessing the impact of these treatments on executive functions and memory using the EpiTrack cognitive screening tool. METHODS: A systematic search identified 1,008 publications, of which 35 full-text articles were reviewed. After applying inclusion criteria, seven studies were included, examining cognitive changes in patients undergoing various treatments. RESULTS: Perampanel and Cenobamate exhibited a neutral cognitive profile, with scores stable at "moderate impairment" (29.67-30.04). Lamotrigine and Levetiracetam demonstrated persistent severe impairment. Brivaracetam improved from severe to moderate impairment (not clinically significant). Only Topiramate showed a clinically significant decline (30.0 to 26.6). VNS therapy led to slight improvement over five years (severe to moderate impairment), while combined VNS + 1-2AEDs produced clinically meaningful gains. In contrast, VNS with 3-4 AEDs maintained severe impairment. CONCLUSION: This review underscores the importance of accurate cognitive assessment in epilepsy management, with a monitoring frequency of no more than every six months for patients receiving AED therapy.