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.

Behavioural co-morbidities in epilepsy

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Psychiatric Disorders ◽  
Antiepileptic Drugs ◽  
Temporal Relationship ◽  
Psychotic Symptoms ◽  
Behavioural Changes ◽  
Forced Normalization ◽  
Clinical Phenomenon ◽  
Clinically Significant ◽  
Patients With Epilepsy

The association between epilepsy and specific behavioural co-morbidities has long been recognized. The most common and clinically significant psychiatric disorders reported by patients with epilepsy encompass affective, anxiety, and psychotic symptoms. Behavioural co-morbidities in epilepsy can be classified according to the temporal relationship with seizures—inter-ictal, peri-ictal (pre-ictal, ictal, post-ictal), and para-ictal symptomatology. Antiepileptic drugs (AEDs) can modulate behavioural changes in patients with epilepsy through different pathways and are directly responsible for the clinical phenomenon of ‘forced normalization’ (‘alternative psychosis’).

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.

‘Soother of mind’ – meditation in psychiatric disorders: a narrative review

2021 ◽  
pp. 1-7
Author(s):  
Vinod Kumar ◽  
Shree Raksha Bhide ◽  
Rashmi Arasappa ◽  
Shivarama Varambally ◽  
Bangalore N. Gangadhar
Keyword(s):  
Psychiatric Disorders ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
Complete Absorption ◽  
Psychiatric Conditions ◽  
Biological Aspects ◽  
The Mind ◽  
Anxiety Depression ◽  
Meditative Practices

SUMMARY Meditation, a component of ashtanga yoga, is an act of inward contemplation in which the mind fluctuates between a state of attention to a stimulus and complete absorption in it. Some forms of meditation have been found to be useful for people with psychiatric conditions such as anxiety, depression and substance use disorder. Evidence for usefulness of meditation for people with psychotic disorders is mixed, with reported improvements in negative symptoms but the emergence/precipitation of psychotic symptoms. This article narrates the benefits of meditation in psychiatric disorders, understanding meditation from the yoga perspective, biological aspects of meditation and practical tips for the practice of meditation. We also explain possible ways of modifying meditative practices to make them safe and useful for the patient population and useful overall as a society-level intervention.

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.

Comparison of Psychiatric Disorders Between Levetiracetam Combined With Lacosamide and Perampanel

2021 ◽  
Author(s):  
Satoru Matsunuma ◽  
Shigeki Sunaga ◽  
Akira Hoshiai ◽  
Takao Arai ◽  
Hiroyuki Jimbo ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Antiepileptic Drugs ◽  
Medical Records ◽  
Medical Center ◽  
Combined Use ◽  
Number Of Patients ◽  
Significant Difference ◽  
Patients With Epilepsy ◽  
Time To Onset ◽  
Dose Dependent

Abstract Background The number of patients with epilepsy receiving perampanel or lacosamide as an add-on treatment following levetiracetam treatment has increased. Although levetiracetam causes psychiatric disorders, it is unclear whether they occur with the combined use of these antiepileptic drugs.Objective To determine the frequency of psychiatric disorders in patients using lacosamide or perampanel as an add-on therapy to levetiracetam. Setting A single-center retrospective cohort study. Methods Patients who received levetiracetam, lacosamide, and perampanel between April 1, 2014 and April 30, 2019 in Hachioji Medical Center were selected. They were classified into the levetiracetam+lacosamide or levetiracetam+perampanel group. Medical records from the start of combination therapy contained patient background and the incidence of psychiatric disorders. Main outcome measure Onset of psychiatric disorders. Results Forty-four patients used levetiracetam+lacosamide and 50 used levetiracetam+perampanel. The incidence of psychiatric disorders was significantly lower (p = 0.000047) with levetiracetam+lacosamide (6.8%) than with levetiracetam+perampanel (46%). The time to the onset of psychiatric disorders was within 1 month of dose initiation or increase in one case (33.3%) with levetiracetam+lacosamide and 16 cases (76.2%) with levetiracetam+perampanel. The median time to onset was 56 and 6.5 days with levetiracetam+lacosamide and levetiracetam+perampanel, respectively. There was no significant difference in antiepileptic drug dosages owing to the presence or absence of psychiatric disorders. Conclusion As the frequency of psychiatric disorders was higher with levetiracetam+perampanel therapy, levetiracetam+lacosamide may be preferable. These disorders tended to develop within 1 month of therapy and were not dose-dependent. Antiepileptic drugs should be cautiously prescribed to avoid psychiatric disorders.

scholarly journals Behavioural variant frontotemporal dementia – selected diagnostic dilemmas in neuropsychiatry

2020 ◽  
Vol 20 (2) ◽  
pp. 71-81
Author(s):  
Marta Kuklińska ◽  
◽  
Emilia J. Sitek ◽  
Bogna Brockhuis ◽  
Anna Barczak ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Psychiatric Disorders ◽  
Frontotemporal Dementia ◽  
Functional Decline ◽  
Psychotic Symptoms ◽  
Obsessive Compulsive ◽  
Behavioural Symptoms ◽  
Hyperactivity Disorder ◽  
Obsessive Compulsive Disorders ◽  
Work Up

Introduction: Differential diagnosis of behavioural variant frontotemporal dementia remains a challenge for neurologists and psychiatrists as some behavioural symptoms of this illness and psychiatric disorders, such as apathy, are not specific. Aim: The paper aims at presenting the differential diagnosis of behavioural variant frontotemporal dementia and primary psychiatric disorders. Discussion: Behavioural symptoms of behavioural variant frontotemporal dementia overlap with symptoms typical for primary psychiatric disorders. Psychotic symptoms, apathy and inappropriate behaviour are prominent in schizophrenia. Repetitive behaviours are typical for obsessive-compulsive disorders. Inattention and impulsivity are common in attention deficit and hyperactivity disorder. Disinhibition is typical of mania in the context of bipolar disorder. Thus, all these psychiatric diagnoses need to be considered in the differential diagnosis of behavioural variant frontotemporal dementia. This condition is associated with language deficits and more widespread executive and social cognition deficits. Also, the presence of neurological symptoms, such as oculomotor dysfunction, upper/lower motor neuron dysfunction or bradykinesia, may facilitate the diagnosis. Functional decline is observed during follow-up in behavioural variant frontotemporal dementia, but not in phenocopy syndrome. Conclusions: Differential diagnosis requires integration of behavioural and neuropsychological data with the results of neurological assessment and neuroimaging work-up. In ambiguous cases, if genetic testing is negative, only longitudinal observation can confirm the diagnosis of behavioural variant frontotemporal dementia or phenocopy syndrome.

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) .

scholarly journals Antiepileptic drugs affect lipid oxidative markers- neuroprostanes and F2-dihomo-isoprostanes- in patients with epilepsy: differences among first-, second-, and third-generation drugs by UHPLC-QqQ-MS/MS

RSC Advances ◽  
2016 ◽  
Vol 6 (86) ◽  
pp. 82969-82976 ◽  
Author(s):  
Sonia Medina ◽  
Rubén Carrasco-Torres ◽  
Ma Isabel Amor ◽  
Camille Oger ◽  
Jean-Marie Galano ◽  
...  
Keyword(s):  
Antiepileptic Drugs ◽  
Antioxidant Status ◽  
Control Group ◽  
Third Generation ◽  
Oxidative Markers ◽  
Epileptic Patients ◽  
New Generation ◽  
Patients With Epilepsy ◽  
Positive Effect

This work show that treatment with new-generation AEDs reduces the excretion of NeuroPs/F2-dihomo-IsoPs to values similar to those in the control group, indicating a positive effect of these AEDs on the antioxidant status of epileptic patients.

scholarly journals Models for predicting treatment efficacy of antiepileptic drugs and prognosis of treatment withdrawal in epilepsy patients

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Shijun Yang ◽  
Bin Wang ◽  
Xiong Han
Keyword(s):  
Antiepileptic Drugs ◽  
Statistical Models ◽  
Prediction Models ◽  
External Validation ◽  
Machine Learning Algorithms ◽  
Treatment Withdrawal ◽  
Patient Treatment ◽  
Recent Developments ◽  
Progression Of Disease ◽  
Patients With Epilepsy

AbstractAlthough antiepileptic drugs (AEDs) are the most effective treatment for epilepsy, 30–40% of patients with epilepsy would develop drug-refractory epilepsy. An accurate, preliminary prediction of the efficacy of AEDs has great clinical significance for patient treatment and prognosis. Some studies have developed statistical models and machine-learning algorithms (MLAs) to predict the efficacy of AEDs treatment and the progression of disease after treatment withdrawal, in order to provide assistance for making clinical decisions in the aim of precise, personalized treatment. The field of prediction models with statistical models and MLAs is attracting growing interest and is developing rapidly. What’s more, more and more studies focus on the external validation of the existing model. In this review, we will give a brief overview of recent developments in this discipline.

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