Professional Documents
Culture Documents
behavioral effects of
antiepileptics
Sun Ah Park
Neurology
Soonchunhyang
University
Bucheon Hospital
Memory
problem
Decreased
concentration
Fatigue
CASE
17 year-old girl
Symptomatic focal epilepsy, daily
seizures, for 15 years
After 8 weeks, starting co-medication
with XXX, the patient had confusion,
anxiety, keep repeating same sentences,
visual hallucinations, and refuse to eat or
drink.
But she had no more seizures.
Cognitive
- Language impairment
- Cognitive slowing
AEDs
PAE or CAE
Psychiatric use
Barbiturates
Depression, Hyperactivity,
Decreased cognition
Sedativehypnotic
withdrawal
Benzodiazepine
Anxiety
disorders,
Alcohol
withdrawal
Carbamazepine
Bipolar disorder
Eslicarbazepine
Ethosuximide
Felbamate
Gabapentin
Lacosamide
Bipolar disorder
AEDs
PAE or CAE
Lamotrigine
Levetiracetam
Psychiatric use
Bipolar disorder
Bipolar disorder
Pregabalin
Generalized
anxiety disorder
Retigabine
AEDs
PAE or CAE
Rufinamide
Tiagabine
Topiramate
Valproate
Decreased cognition,
Encephalopathy, decreased IQ secondary
to fetal exposure
Vigabatrin
Zonisamide
Psychiatric use
Bipolar
disorder
Psychosis
2~3 times higher in epilepsy
anger/hostility behavior, aggressive or
agitated behavior, irritability, and
emotion liability.
Others
Aggressive behavior
Psychosis
Affective behavior
Psychosis
TPM
ZNS
LEV
PHT
PGB
Others
LTG
Rate
ZNS
Psychosis mechanism
VDSC, TCC
EC dopamine level in
striatum and hippo
TPM
LEV
5/58 (discontinuation),
decrease with time (20/56,
36% 1M 8/56, 14% 6M)
Cognitive dysfunction
Hard to compare
Different seizure types
Poor and variable definition of cognitive
functions
Cognition
TPM
Barbiturates
BZO
ZNS
CBZ
PHT
VPA
PGB
OXC
GBP
GVG
LTG
LEV
Rate
CAE
TPM
PB
Frequent
ZNS
4~12%, 27~35%,
Dose-related
PHT
Dose-related
CBZ
Dose-related
VPA
PGB
Memory
FA
Barbiturates
Carbamazepine or Lamotrigine
Polytherapy
With VPA, TPM, CBZ
Not with LEV
Dose-related
PHT, CBZ, TPM, VPA
Depression
Measuring depression scale
Suicidal rate
Mechanism
Drug-induced folate deficiency
Enhanced GABA transmission (?) GABA
enhancer can be effective in depression
More in patients with HS
Depresssion
Barbiturates
BZO
TGB
GVG
FBM
LEV
TPM
ZNS
CBZ
LMT
VPA
Suicide
~200 placebo controlled trials of 11
AEDs involving 44,000 patients
0.43% risk with AED vs. 0.22% risk in
placebo, 3~5 high
High, PWE with a psychiatric diagnosis,
13, anxiety and bipolar illness
Recommended warning for all patients
prescribed AEDs
Biological vulnerability
History of febrile convulsion
Limbic abnormality, functional
abnormality > structural abnormality
Hippocampal sclerosis
TLE with HS: vulnerable to TPX related
deression
Activating
fatigue,
cognitive slowing,
weight gain
anxiogenic,
antidepressant properties
CASE
Managements
At start
When PSE
developed
If persists
Start medication
Consultation to psychiatrists
Psychosis
Atypical antipsychotics are preferred
Relatively low rate of inducible seizure by
antipsychotics, 0.5~1.2%
Avoid rapid titration, high doses,
clozapine, chlorpromazine, loxapine
Cognitive function
LEV, LMT is beneficial?
Depression
Depression rating scale
Symptom checklist-90-revised (SCL-90-R)
Scale for suicide ideation-Beck (SSI-Beck)
Anxiety
Approaches are similar to those for
depression, SSRIs and SNRIs, paroxetine,
escitalopram, venlafaxine
Avoid long-term use of BZO
References