Mr. Trimble et al., Psychiatric symptoms after therapy with new antiepileptic drugs: Psychopathological and seizure related variables, SEIZURE-E J, 9(4), 2000, pp. 249-254
The purpose of this paper is to understand the association between antiepil
eptic drugs (AEDs), patient characteristics, changes in seizure pattern and
emergent psychiatric disorder, i.e. psychosis or affective disorder. To th
is end we carried out a retrospective casenote study on 89 patients who dev
eloped psychiatric symptoms during treatment with topiramate, vigabatrin or
tiagabine. The psychiatric problem was either an affective or a psychotic
disorder (not including affective psychoses). It was discovered that 99% of
the patients suffered from complex partial seizures with or without second
ary generalization. More than half were on polytherapy with two or more oth
er AEDs. Nearly two-thirds had a previous psychiatric history. There was a
strong association between the type of previous psychiatric illness and the
type of emerging psychiatric problem, both for psychoses and for affective
disorders. Patients on vigabatrin had an earlier onset of epilepsy and mor
e neurological abnormalities than those on topiramate. Those patients on lo
wer doses had a shorter interval between the start of the AED therapy and t
he onset of the psychiatric problem. A seizure-free period was observed in
more than half of the patients before they developed the psychiatric sympto
ms, and of these more were likely to develop a psychosis rather than an aff
ective disorder. There seemed to be an association of suppression of right-
sided seizures and the onset of the psychiatric problem. The conclusions dr
awn were that patients with a previous history of psychosis or affective di
sorder tended to develop the same psychiatric problem with new AEDs. Those
with a seizure-free period before the onset of the psychiatric problem were
more likely to develop a psychosis than an affective disorder. (C) 2000 BE
A Trading Ltd.