<![CDATA[Introduction: Epilepsy is a chronic neurological disorder characterized by recurrent seizures, significantly impacting patients' quality of life. The management of epilepsy primarily involves pharmacological interventions aimed at reducing seizure frequency and improving neurological function. Recent advancements in antiepileptic drugs (AEDs) have provided new options, particularly for patients with refractory epilepsy. Methods: This systematic review evaluated the long-term neurological and cognitive outcomes of various pharmacological interventions for adults with chronic epilepsy. Studies were included if they involved adult participants, examined AEDs, measured cognitive or neurological outcomes, and had a follow-up period of at least 12 months. A comprehensive search was conducted across multiple databases, yielding 40 relevant studies. Results: The findings indicate that newer AEDs, such as brivaracetam and cenobamate, demonstrate significant efficacy in reducing seizure frequency, with median reductions ranging from 48.8% to 78%. However, cognitive effects varied; while some medications like topiramate had low incidences of cognitive adverse events, others such as carbamazepine were associated with declines in cognitive function. Discussion: The interplay between seizure control and cognitive outcomes is complex. Improved seizure management may lead to positive neurological adaptations, although certain AEDs can adversely affect cognitive function. The variability in outcomes underscores the need for individualized treatment approaches based on patient-specific factors. Conclusion: Long-term pharmacotherapy for epilepsy reveals a dual narrative of efficacy and cognitive impact. While advancements have improved seizure control, careful consideration of cognitive side effects is essential for optimizing patient outcomes.]]>
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