Occurrence of Psychosis in Patients with Epilepsy Randomized to Tiagabine or Placebo Treatment

Sackellares, J. Chris; Krauss, Gregory L.; Sommerville, Kenneth W.; Deaton, Roger

doi:10.1046/j.1528-1157.2002.16000.x

Cited by 28 publications

(6 citation statements)

References 19 publications

(16 reference statements)

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“…Only a few controlled studies have focused on the comparison between AEDs and non-AEDs in this regard, except for several clinical trials with placebo-controlled procedures. [31][32][33] In the current study, we confirmed the psychogenetic potential of AED. Furthermore, SAEDs have a higher psychogenic potential than that of FAEDs.…”

Section: State-dependent (Inconsistent) Variablessupporting

confidence: 82%

Individual vulnerabilities to psychosis after antiepileptic drug administration

Akanuma

Adachi²,

Fenwick

et al. 2020

BMJ Neurol Open

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BackgroundPsychosis often develops after the administration of antiepileptic drugs (AEDs) in patients with epilepsy. However, the individual vulnerability and clinical condition of such patients have been rarely scrutinised. We investigated the effect of individually consistent (trait-dependent) and inconsistent (state-dependent) characteristics.MethodsThe individual characteristics, clinical states and psychotic outcome of patients from eight adult epilepsy clinics were retrospectively reviewed over 6-month periods after a new drug (AED or non-AED) administration between 1981 and 2015.ResultsA total of 5018 new drugs (4402 AEDs and 616 non-AEDs) were used in 2015 patients with focal epilepsy. Subsequently, 105 psychotic episodes (81 interictal and 24 postictal) occurred in 89 patients. Twelve patients exhibited multiple episodes after different AED administrations. Trait-dependent characteristics (early onset of epilepsy, known presumed causes of epilepsy, lower intellectual function and a family history of psychosis) were significantly associated with the patients who exhibited psychosis. Absence of family history of epilepsy was also associated with psychosis but not significantly. Subsequent logistic regression analysis with a model incorporating family history of psychosis and epilepsy, and intellectual function was the most appropriate (p=0.000). State-dependent characteristics, including previous psychotic history and epilepsy-related variables (longer duration of epilepsy, AED administration, higher seizure frequency and concomitant use of AEDs) were significantly associated with psychotic episodes. Subsequent analysis found that a model including AED administration and previous psychotic history was the most appropriate (p=0.000).ConclusionPsychosis occurring after new AED administration was related to the individual vulnerability to psychosis and intractability of epilepsy.

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Section: State-dependent (Inconsistent) Variablessupporting

confidence: 82%

Individual vulnerabilities to psychosis after antiepileptic drug administration

Akanuma

Adachi²,

Fenwick

et al. 2020

BMJ Neurol Open

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“…Some authors have strongly advocated that any potent AED can precipitate psychosis precisely because of the potent anticonvulsant effects and that a subgroup of patients is particularly vulnerable to dramatic seizure reduction, irrespective of the AED used. In contrast, there are reports of psychotic symptoms specifically after exposure to certain AEDs [30,31,32,33] (including; ethosuximide [34], topiramate [35], felbamate [36], levetiracetam [37], zonisamide [38] ,vigabatrin [39], tiagabine [40] and lacosamide [41].…”

Section: Do Specific Antiepileptic Drugs Increase the Risk Of Psychoses In Pwe?mentioning

confidence: 99%

Pharmacotherapy in patients with epilepsy and psychosis

Toffol

Trimble

Hesdorffer

et al. 2018

Epilepsy & Behavior

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The recognition and treatment of psychosis in persons with epilepsy (PWE) is recommended with the apparent dilemma between treating psychosis and opening the possibility of exacerbating seizures. The pooled prevalence estimate of psychosis in PWE is 5.6%. It has been proposed that a 'two hit' model, requiring both aberrant limbic activity and impaired frontal control, may account for the wide range of clinical phenotypes. The role of antiepileptic drugs in psychosis in PWE remains unclear. Alternating psychosis, the clinical phenomenon of a reciprocal relationship between psychosis and seizures, is unlikely to be an exclusively antiepileptic drug-specific phenomenon but rather, linked to the neurobiological mechanisms underlying seizure control. Reevaluation of antiepileptic treatment, including the agent/s being used and degree of epileptic seizure control is recommended. The authors found very few controlled studies to inform evidence-based treatment of psychosis in PWE. However, antipsychotics and benzodiazepines are recommended as the symptomatic clinical treatments of choice for postictal and brief interictal psychoses. The general principle of early symptomatic treatment of psychotic symptoms applies in epilepsy-related psychoses, as for primary psychotic disorders. In the authors' experience, low doses of antipsychotic medications do not significantly increase clinical risk of seizures in PWE being concurrently treated with an efficacious antiepileptic regimen.

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“…Placebo‐controlled studies of tiagabine showed that the risk of psychosis was not significantly increased (Sackellares et al 2002). However, the paradoxical provocation of de novo , non‐convulsive status epilepticus is a specific issue reported by different authors (Schapel and Chadwick 1996) and, in some selected cases, there may be a differential diagnosis with brief ictal psychotic episodes (Trimble 1991).…”

Section: Psychosesmentioning

confidence: 99%

Antiepileptic drugs and psychopathology of epilepsy: an update

Mula

Monaco²

2009

Epileptic Disorders

128

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Anti-epileptic drugs (AEDs) continue to be the mainstay of epilepsy treatment, but the benefits of seizure control need to be weighed carefully against possible adverse effects, which can include behavioral problems and psychiatric disorders. In this paper, the associations between AEDs and psychosis, depression and behavioral changes are reviewed. The concept of forced normalization and its clinical counterpart, alternative psychosis, are also discussed. Depression seems to be linked with AEDs potentiating GABAergic neurotransmission in patients with limbic system abnormalities such as hippocampal sclerosis. Psychoses have been described as associated with several of the new AEDs, and they are often seen in a setting in which previously refractory patients suddenly become seizure-free. In general terms, the use of AEDs in monotherapy, adopting slow titration schedules and low doses when possible, can significantly reduce the occurrence of behavioral adverse effects. A previous history of psychiatric disorder or a familial predisposition are important risk factors and should be always considered when choosing the appropriate AED.

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Occurrence of Psychosis in Patients with Epilepsy Randomized to Tiagabine or Placebo Treatment

Cited by 28 publications

References 19 publications

Individual vulnerabilities to psychosis after antiepileptic drug administration

Individual vulnerabilities to psychosis after antiepileptic drug administration

Pharmacotherapy in patients with epilepsy and psychosis

Antiepileptic drugs and psychopathology of epilepsy: an update

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