Phenobarbital and primidone

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Twentieth Century ◽  
Antiepileptic Drug ◽  
Psychiatric Disorders ◽  
Antiepileptic Drugs ◽  
First Generation ◽  
Developing World ◽  
Tolerability Profile ◽  
Behavioural Symptoms ◽  
Safety Issues ◽  
Patients With Epilepsy

Phenobarbital and primidone are first-generation antiepileptic drugs currently associated with restricted ranges of antiepileptic indications, despite their acceptable interaction profiles in polytherapy. Although phenobarbital is still widely prescribed as antiepileptic drug in the developing world, safety issues (including risks of dependence and overdose), together with the development of other antiepileptic drugs throughout the second half of the twentieth century, left little room for the use of barbiturates in patients with epilepsy. Both phenobarbital and primidone are barbiturates with an acceptable behavioural tolerability profile, but there are no approved indications or clinical uses for the treatment of behavioural symptoms in patients with psychiatric disorders.

Carbamazepine, oxcarbazepine, and eslicarbazepine

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Bipolar Disorder ◽  
Antiepileptic Drug ◽  
Clinical Experience ◽  
First Generation ◽  
Tolerability Profile ◽  
Third Generation ◽  
Acceptable Risk ◽  
Behavioural Symptoms ◽  
Patients With Epilepsy ◽  
Good Range

Carbamazepine is a first-generation antiepileptic drug characterized by a good range of antiepileptic indications, with acceptable risk of interactions in polytherapy. Carbamazepine has a very good behavioural tolerability profile and is in widespread psychiatric use (indication for bipolar disorder—acute mania). Oxcarbazepine and eslicarbazepine are carbamazepine derivatives. Oxcarbazepine is a second-generation antiepileptic drug characterized by a good range of antiepileptic indications, with acceptable risk of interactions in polytherapy. Like carbamazepine, oxcarbazepine has a very good behavioural tolerability profile and potential for widespread psychiatric use. Eslicarbazepine is a third-generation antiepileptic drug for which clinical experience is still limited. Little is known about its positive and negative psychotropic properties and their implications for the management of behavioural symptoms in patients with epilepsy.

Other antiepileptic drugs: rufinamide, lacosamide, perampanel

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Psychiatric Disorders ◽  
Antiepileptic Drugs ◽  
Clinical Experience ◽  
Psychotic Symptoms ◽  
Third Generation ◽  
Behavioural Symptoms ◽  
Patients With Epilepsy ◽  
Anxiety Depression

Rufinamide, lacosamide, and perampanel are third-generation agents licensed for use as antiepileptic drugs in recent years. Clinical experience is still limited, and little is known about their positive and negative psychotropic properties or their implications for the management of behavioural symptoms in patients with epilepsy. There are initial reports of anxiety, depression, irritability, and agitation in patients with epilepsy treated with rufinamide, whereas depression, irritability, agitation, and psychotic symptoms have been reported during lacosamide treatment. There are initial reports of behavioural disturbances (especially depression, anxiety, irritability, and psychosis) in patients with epilepsy treated with perampanel. These effects seem to be dose-related and tend to appear within the first weeks of treatment. Overall, these antiepileptic drugs have no indications for the treatment of psychiatric disorders and there is insufficient experience to draw any conclusion regarding their psychotropic profiles.

Valproate

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Antiepileptic Drug ◽  
Affective Disorder ◽  
Maintenance Treatment ◽  
First Generation ◽  
Bipolar Affective Disorder ◽  
Tolerability Profile ◽  
First Line ◽  
Behavioural Symptoms ◽  
Formal Indication ◽  
Wide Range

Valproate is a first-generation antiepileptic drug characterized by a wide range of antiepileptic indications, with an acceptable interaction profile in polytherapy. Valproate has a good behavioural tolerability profile, despite the existence of occasional reports of depression, irritability, and other behavioural symptoms in patients with encephalopathy. Valproate is also characterized by a wide range of psychiatric uses. Most importantly, valproate is an effective mood stabilizser, with a licensed indication for the treatment of acute mania in patients with bipolar affective disorder. Although it has no formal indication, it is also considered as a first-line agent for maintenance treatment in bipolar affective disorder.

Comparative evidence and clinical scenarios

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Patient Population ◽  
Psychiatric Symptoms ◽  
Rapid Expansion ◽  
Cognitive Effects ◽  
Behavioural Symptoms ◽  
Clinical Scenarios ◽  
Available Information ◽  
Patients With Epilepsy

By bringing together the available information from the use of individual antiepileptic drugs in patients with epilepsy, it is possible to derive some preliminary comparative evidence about their positive and negative psychotropic properties, as well as their implications for the management of behavioural symptoms in this patient population. These findings often match the available evidence supporting the use of antiepileptic drugs for the treatment of patients with primary psychiatric symptoms. Expertise on the relative advantages/disadvantages of each antiepileptic drug in different clinical situations requires up-to-date knowledge about the behavioural and cognitive effects of these medications (a task made increasingly more difficult by the rapid expansion of the field) .

Frequency of drug combinations between enzyme-inducing first-generation antiepileptic drugs and inducible drugs in patients with epilepsy

2018 ◽  
Vol 87 ◽  
pp. 92-95 ◽  
Author(s):  
Gaetano Zaccara ◽  
Elisa Gualdani ◽  
Laura Policardo ◽  
Pasquale Palumbo ◽  
Paolo Francesconi
Keyword(s):  
Antiepileptic Drugs ◽  
First Generation ◽  
Drug Combinations ◽  
Patients With Epilepsy

Zonisamide

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Bipolar Disorder ◽  
Weight Gain ◽  
Adverse Effects ◽  
Alcohol Dependence ◽  
Antiepileptic Drug ◽  
Preliminary Evidence ◽  
Tolerability Profile ◽  
Patients With Epilepsy ◽  
Psychiatric Adverse Effects ◽  
Acceptable Tolerability Profile

Zonisamide is a second-generation antiepileptic drug characterized by a few antiepileptic indications, with an acceptable interaction profile in polytherapy. Zonisamide has an acceptable tolerability profile in patients with epilepsy, with depression, irritability, agitation and psychosis as the most commonly reported psychiatric adverse effects. Zonisamide has no approved indications or clinical uses in psychiatry, as initial findings from uncontrolled studies suggesting effectiveness in the treatment of patients with bipolar disorder did not find confirmation. There is preliminary evidence for possible usefulness of zonisamide in the treatment of patients with obesity and psychotropic-associated weight gain, as well as alcohol dependence and withdrawal.

Vigabatrin

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Adverse Effects ◽  
Antiepileptic Drug ◽  
Routine Clinical Practice ◽  
Visual Field Defects ◽  
Tolerability Profile ◽  
Psychiatric History ◽  
Weak Evidence ◽  
Patients With Epilepsy ◽  
Psychiatric Adverse Effects ◽  
Field Defects

Vigabatrin is a second-generation antiepileptic drug characterized by a few antiepileptic indications, with a very good interaction profile in polytherapy. Clinically relevant adverse effects (especially visual field defects) have reduced its use as antiepileptic drug in routine clinical practice considerably. Vigabatrin has an acceptable behavioural tolerability profile, although patients with epilepsy treated with this medication can report depression, psychosis, and irritability. Risk factors for developing psychiatric adverse effects include high starting and maintenance doses, past psychiatric history, and epilepsy severity. Vigabatrin has no approved indications or clinical uses in psychiatry, despite weak evidence for its usefulness in the treatment of anxiety disorders and addictions.

Phenytoin

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
First Generation ◽  
Mood Stabilizer ◽  
Therapeutic Index ◽  
Tolerability Profile ◽  
Pharmacological Management ◽  
Impulsive Aggression ◽  
Weak Evidence ◽  
Patients With Epilepsy ◽  
Higher Doses

Phenytoin is a first-generation antiepileptic drug characterized by a good range of antiepileptic indications, with an acceptable interaction profile in polytherapy. The reasons for the decreased use of phenytoin in patients with epilepsy include its narrow therapeutic index and potential for long-term toxicity, as well as the development of other antiepileptic drugs throughout the second half of the twentieth century. Phenytoin has a good behavioural tolerability profile and a restricted range of psychiatric uses. Despite occasional reports of adverse behavioural effects (especially at higher doses), there is some weak evidence for its potential usefulness as mood stabilizer and in the pharmacological management of impulsive aggression.

Levetiracetam, piracetam, and brivaracetam

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Antiepileptic Drug ◽  
Bipolar Depression ◽  
Psychotic Symptoms ◽  
Tolerability Profile ◽  
Third Generation ◽  
Emotional Lability ◽  
Depression And Anxiety ◽  
Nootropic Drug ◽  
Wide Range ◽  
Patients With Epilepsy

Levetiracetam is a third-generation antiepileptic drug characterized by a wide range of antiepileptic indications, with a very good interaction profile in polytherapy. Levetiracetam has an acceptable behavioural tolerability profile, but limited potential for psychiatric uses. Behavioural adverse events (irritability and emotional lability) are often reported by patients with epilepsy taking levetiracetam; psychotic symptoms and episodes of severe aggression have occasionally been reported. Initial reports suggesting a possible role for levetiracetam in the treatment of bipolar depression and anxiety disorders have not been confirmed by the findings of controlled trials. Two other pyrrolidone derivatives chemically related to levetiracetam, the nootropic drug piracetam and the third-generation antiepileptic drug brivaracetam, do not have psychiatric uses.

Ethosuximide

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Adverse Effects ◽  
Antiepileptic Drug ◽  
First Generation ◽  
Adult Patients ◽  
Psychotic Symptoms ◽  
Tolerability Profile ◽  
Seizure Recurrence ◽  
Forced Normalization ◽  
Time Relation

Ethosuximide is a first-generation antiepileptic drug characterized by few antiepileptic indications, with acceptable interaction profile in polytherapy. Ethosuximide has a good behavioural tolerability profile, but no approved indications or clinical uses in psychiatry. Behavioural adverse effects can sometimes occur following cessation of seizures and normalization of the EEG and resolve with discontinuation of Ethosuximide and seizure recurrence. Specifically, there are reports of psychosis (but no aggression-related behaviours) in adult patients treated with Ethosuximide. Since the psychotic symptoms tend to occur in clear time relation to the Ethosuximide treatment, it seems plausible that they are manifestations of alternative psychosis in the context of forced normalization.

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