Treatment of psychoses in patients with epilepsy: an update

Agrawal, Niruj; Mula, Marco

doi:10.1177/2045125319862968

Cited by 49 publications

(51 citation statements)

References 60 publications

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“…The most frequent type of seizures were complex focal seizures. AP/FN is rare in patients with mainly generalized tonic-clonic seizures and in extra-temporal lobe epilepsy (Agrawal and Mula, 2019).…”

Section: Type Of Epilepsymentioning

confidence: 99%

“…With regard to the clinical presentation, no new findings have emerged in recent years. The clinical presentation is nonspecific and there are no generally agreed diagnostic criteria for AP/FN (Agrawal and Mula, 2019). AP/FN generally presents with behavioral disturbances of acute or subacute onset, associated with thought disorder, delusions, hallucinations, significant mood change (hypomania or depression), and anxiety with depersonalization or derealization symptoms.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Other names for the alternation between periods of clinically manifest seizures and normal behavior are the following: para-ictal psychosis (Agrawal and Mula 2019), paradoxical normalization (Wolf, 1991) and Landolt's phenomenon (Mula, 2010). Also, in 2019, there are no generally agreed diagnostic criteria for AP and FN (Agrawal and Mula, 2019). The terms AP and FN are not used in the ICD-10 (International Statistical Classification of Diseases and Related Health Problems) and DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).…”

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics of forced normalization and alternative psychosis with special consideration of the new anticonvulsants

Fröscher

Faust

Steinert

2020

Journal of Epileptology

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Background. In the case of an alternative psychosis (AP) or forced normalization (FN), the patient alternates between periods of clinically manifest seizures and normal behavior, and other periods of seizure freedom or significant seizure reduction accompanied by psychosis or behavioral disturbances. In clinical practice and in the literature, the terms AP and FN are mostly used synonymously despite small differences. FN of the EEG is not only common to interictal mental disturbances but may also occur in the case of pre-ictal and postictal mental disturbances. Aim. To update the 2007 review on "Alternative Psychoses of Epilepsy" in this journal with special consideration of the new anticonvulsants. Material and Methods. We conducted a literature research from 1987 (in this year a psychosis, triggered by the first "new "anticonvulsant vigabatrin in a patient with epilepsy was reported for the first time) up to September 2019. Discussion. AP/FN are rare events; only 10% of epileptic psychosis are AP/FN. AP/FN respectively occur with both generalized and focal epilepsy; in recent years, patients with focal epilepsy predominate. AP/FN generally present with behavioral disturbances of acute or subacute onset associated with thought disorder, delusions, hallucinations, significant mood change, or anxiety with depersonalization and derealization symptoms. The reports on EEG findings in patients with AP are inconsistent. In the case of FN, the EEG is by definition normal or substantially improved. The most prominent risk factor for the development of an AP/FN is the anticonvulsant medication. The following anticonvulsants have not been observed until now as triggers of an AP/FN in the literature reviewed by us: Acetazolamide and sulthiame ("old" anticonvulsants) and the "new" anticonvulsants brivaracetam, eslicarbazepine, pregabalin, retigabine, rufinamide, stiripentol. The treatment is based on 3 strategies: Reduction or complete cessation of anticonvulsants, change of anticonvulsants and administration of antipsychotic drugs. Conclusion. The risk of an AP/FN is probably different for the individual dugs. At the current level of experience, gabapentin, pregabalin, oxcarbazepine or eslicarbazepine can be the first alternative if an AP/FN was triggered by another anticonvulsant in a patient with focal epilepsy. In generalized epilepsy, especially in patients with absences, valproic acid remains the first alternative.

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Section: Type Of Epilepsymentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics of forced normalization and alternative psychosis with special consideration of the new anticonvulsants

Fröscher

Faust

Steinert

2020

Journal of Epileptology

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“…Neuropsychiatric disorders such as mood, anxiety and psychotic disorders are observed in about 30-70% of TLE patients and these comorbidities have a significant impact on the patient's quality of life (6)(7)(8). In TLE, comorbid depression has the highest prevalence (42.9%) followed by anxiety disorders (18.4%), especially generalized anxiety disorder (GAD), while psychosis shows a lower prevalence (around 5-7%) (9,10).…”

Section: Introductionmentioning

confidence: 99%

Lowered Paraoxonase 1 Activities May Explain the Comorbidities Between Temporal Lobe Epilepsy or Mesial Temporal Sclerosis and Comorbid Depression, Anxiety and Psychosis

Michelin¹,

Maes²,

Supasitthumrong³

et al. 2020

Preprint

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Background: Temporal lobe epilepsy (TLE) is the most common focal epilepsy subtype in adults and is frequently accompanied by depression, anxiety and psychosis. Aberrations in total paraoxonase (PON)1 status may occur in TLE and those psychiatric conditions. Methods: We examined paraoxonase (PON)1 status, namely Q192R PON1 genotypes and PON1 enzymatic activities, in 40 normal controls and 104 TLE patients, 27 without comorbidities, and 77 with comorbidities including mood disorders (n=25), anxiety disorders (n=27) and psychosis (n=25). Outcomes: CMPAase and arylesterase activities were significantly lower in TLE and mesial temporal sclerosis (MTS) with and without psychiatric comorbidities than in normal controls. The areas under the ROC curve of CMPAase were 0.893 (0.037) for TLE and 0.895 (±0.037) for MTS. Partial Least Squares (PLS) path analysis showed that there were specific indirect effects of PON1 genotype on TLE severity (p<0.0001) and psychopathology (p<0.0001), which were both mediated by lowered CMPAase activity, while arylesterase activity was not significant. The severity of TLE was significantly associated with psychopathology scores. Furthermore, PON1 CMPAase activity was inversely associated with Mini Mental State Examination scores. Interpretation: The severity of TLE and comorbidities are to a large extent explained by lowered PON1 enzyme activities and by effects of the Q192R genotype which are mediated by lowered CMPAase activity. Total PON1 status plays a key role in the pathophysiology of TLE, MTS and psychiatric comorbidities by increasing the risk of oxidative toxicity. PON1 enzyme activities are new drug targets in TLE to treat seizure frequency and psychiatric comorbidities.

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“…The relationship between epilepsy and psychosis is multifaceted and probably related to a wide range of different mechanisms. It can be highlighted, for example, that neuroimaging studies in schizophrenia have shown abnormalities in brain networks overlapping those involved in temporal lobe epilepsy, particularly in the amygdala and the hippocampus (Agrawal & Mula, 2019).…”

Section: Discussionmentioning

confidence: 99%

High frequency of clinical conditions commonly associated with mitochondrial disorders in schizophrenia

Alonso

Valiente-Pallejà

Verge

et al. 2020

Acta Neuropsychiatr.

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Objective: It has been hypothesized that neuropsychiatric symptoms, including psychosis, can be the result of a milder brain bioenergetic defect produced by mitochondrial dysfunction; however, mitochondrial dysfunction can be present in other organs or systems. The aim of the study was to investigate whether clinical conditions associated with mitochondrial disorders (CAMDs) were frequently present in schizophrenia. Methods: A previously used questionnaire regarding the CAMDs was administered to patients and controls in a direct interview with a trained psychiatrist. The frequencies of CAMDs in 164 patients with schizophrenia were compared to those in 156 age- and sex-matched controls. Results: Severe fatigue, seizures, constipation and diabetes were significantly more frequent in patients with schizophrenia than in control subjects and apparently not related to pharmacological treatment. Conclusion: The results of the present study suggest that multi-systemic mitochondrial dysfunction may be an underlying mechanism involved in schizophrenia.

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Treatment of psychoses in patients with epilepsy: an update

Cited by 49 publications

References 60 publications

Clinical characteristics of forced normalization and alternative psychosis with special consideration of the new anticonvulsants

Clinical characteristics of forced normalization and alternative psychosis with special consideration of the new anticonvulsants

Lowered Paraoxonase 1 Activities May Explain the Comorbidities Between Temporal Lobe Epilepsy or Mesial Temporal Sclerosis and Comorbid Depression, Anxiety and Psychosis

High frequency of clinical conditions commonly associated with mitochondrial disorders in schizophrenia

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