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[Guidelines for the management of adverse effects of anti-seizure medications (2023)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:889-900. [PMID: 37718393 PMCID: PMC10511233 DOI: 10.7499/j.issn.1008-8830.2306016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/28/2023] [Indexed: 09/19/2023]
Abstract
Epilepsy is a prevalent neurological disorder with a complex etiology and an unclear pathogenesis. In order to standardize the management of adverse effects caused by anti-seizure medications (ASMs), the Youth Committee of the Chinese Association Against Epilepsy (CAAE), in collaboration with the CAAE Precision Medicines and Adverse Effect Monitoring Committee, has developed a guideline: guidelines for the management of adverse effects of anti-seizure medications (2023). This guideline addresses 13 clinical questions related to the management of adverse effects of ASMs in the nervous system, cardiovascular system, and fetus. Its primary objective is to provide guidance to medical professionals specializing in pediatric neurology, neurology, and neurosurgery in China, and to facilitate their clinical practice.
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Hussain M, Rashid H, Katyal J. Response to sertraline and antiepileptic drugs in pentylenetetrazole kindling in rats. Brain Res 2021; 1771:147645. [PMID: 34480951 DOI: 10.1016/j.brainres.2021.147645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
Anti-epileptic drugs (AEDs) are the mainstay of epilepsy treatment but these may be a potential risk factor for behavioral disturbances particularly depression which requires treatment. In this study, the effect of antidepressant sertraline (SRT) in combination with AEDs sodium valproate (SV) and levetiracetam (LEV) on seizures, cognitive impairment and oxidative stress in rats was evaluated. After administration of 24th injection of pentylenetetrazole (PTZ), 77.8% rats were kindled. Administration of SRT showed no protective effect on kindling development while SV was 100% protective. With LEV 42.9% were kindled. On combining SRT with SV or LEV 25% and 20% rats were kindled. A significant increase in latency to reach platform zone in Morris water maze(MWM), and increased transfer latencies in Elevated plus maze(EPM) was observed in PTZ kindled rats as compared to normal control on day 49 and when LEV was combined with SRT. In EPM test, however none of the drug treatments had any effect on transfer latencies except LEV pretreated kindled group. In Passive avoidance (PA) test, kindling was associated with a significant decrease in retention time(p = 0.018) while LEV and SV had no effect. The PTZ kindled rats showed significantly higher malondialdehyde(MDA) levels in brain hippocampus(p = 0.0286) while both SRT and SV were associated with significantly lower MDA levels as compared to kindled control group. In case of glutathione (GSH), kindling had no significant effect. The use of sertraline for depression in persons with epilepsy on AEDs needs to be carefully evaluated and monitored due to likelihood of individual variation.
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Affiliation(s)
- Md Hussain
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Haroon Rashid
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jatinder Katyal
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
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Bagheri S, Haddadi R, Saki S, Kourosh-Arami M, Komaki A. The effect of sodium channels on neurological/neuronal disorders: A systematic review. Int J Dev Neurosci 2021; 81:669-685. [PMID: 34687079 DOI: 10.1002/jdn.10153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 12/19/2022] Open
Abstract
Neurological and neuronal disorders are associated with structural, biochemical, or electrical abnormalities in the nervous system. Many neurological diseases have not yet been discovered. Interventions used for the treatment of these disorders include avoidance measures, lifestyle changes, physiotherapy, neurorehabilitation, pain management, medication, and surgery. In the sodium channelopathies, alterations in the structure, expression, and function of voltage-gated sodium channels (VGSCs) are considered as the causes of neurological and neuronal diseases. Online databases, including Scopus, Science Direct, Google Scholar, and PubMed were assessed for studies published between 1977 and 2020 using the keywords of review, sodium channels blocker, neurological diseases, and neuronal diseases. VGSCs consist of one α subunit and two β subunits. These subunits are known to regulate the gating kinetics, functional characteristics, and localization of the ion channel. These channels are involved in cell migration, cellular connections, neuronal pathfinding, and neurite outgrowth. Through the VGSC, the action potential is triggered and propagated in the neurons. Action potentials are physiological functions and passage of impermeable ions. The electrophysiological properties of these channels and their relationship with neurological and neuronal disorders have been identified. Subunit mutations are involved in the development of diseases, such as epilepsy, multiple sclerosis, autism, and Alzheimer's disease. Accordingly, we conducted a review of the link between VGSCs and neurological and neuronal diseases. Also, novel therapeutic targets were introduced for future drug discoveries.
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Affiliation(s)
- Shokufeh Bagheri
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Neuroscience, School of Science and Advanced Technologies in Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rasool Haddadi
- Department of Pharmacology, School of Pharmacy, Hamadan University of Medical Science, Hamadan, Iran
| | - Sahar Saki
- Vice-Chancellor for Research and Technology, Hamadan University of Medical Science, Hamadan, Iran
| | - Masoumeh Kourosh-Arami
- Department of Neuroscience, School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Komaki
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Neuroscience, School of Science and Advanced Technologies in Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Lin CH, Hsieh CL. Chinese Herbal Medicine for Treating Epilepsy. Front Neurosci 2021; 15:682821. [PMID: 34276290 PMCID: PMC8284486 DOI: 10.3389/fnins.2021.682821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Chinese herbal medicine has a long history of use for treating epilepsy. Because of the side effects of Western antiepileptic therapy and the quest for more accessible treatment, complementary and alternative medicines have become popular. Traditional Chinese medical diet therapy appears to be safe and effective. We searched PubMed and the Cochrane Library through November 2020 for the use of traditional Chinese medicine in clinical settings, including plants, fungi, and animals. Combinations of keywords included “epilepsy,” “seizure,” “antiepileptic,” “anticonvulsive,” “Chinese herbal medicine,” “Chinese herb,” and each of the Latin names, English names, and scientific names of herbs. We also summarized the sources and functions of these herbs in Chinese medicine. Different herbs can be combined to increase antiepileptic effects through various mechanisms, including anti-inflammation, antioxidation, GABAergic effect enhancement, modulation of NMDA channels and sodium channel, and neuroprotection. Despite reports of their anticonvulsive effects, adequate experimental evidence and randomized controlled clinical trials are required to confirm their antiepileptic effects.
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Affiliation(s)
- Chia-Hui Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,Chinese Medicine Research Center, China Medical University, Taichung, Taiwan.,Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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Rashid H, Katyal J, Sood M, Tripathi M. Depression in persons with epilepsy: A comparative study of different tools in Indian population. Epilepsy Behav 2021; 115:107633. [PMID: 33309426 DOI: 10.1016/j.yebeh.2020.107633] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Depression is an important co-morbidity in persons with epilepsy (PWE) and its timely identification is essential. The aim of the study was to assess and compare the psychometric properties of potentially suitable screening tools of depression in PWE in a tertiary care setting in India. METHODS After ethical clearance, 449 PWE above 18 years of age, on anti-seizure drugs (ASDs), attending epilepsy clinic in neurology outpatient department (OPD) of All India Institute of Medical Sciences, New Delhi, India, were recruited and evaluated for depression using different tools namely: Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Patient Health Questionnaire (PHQ-9) and Hamilton Depression Rating Scale (HAM-D). Mini International Neuropsychiatric Interview (MINI: Module A, version 6.0.0) was used as reference standard. The association if any of depression with PWE variables was also determined. RESULTS A variable percentage of PWE were positive for depression- 40.1% with MINI, 40.5% with NDDI-E, 44.3% with HAM-D and 45.4% with PHQ-9. Suicidal ideation was present in 4.5% of PWE. The sensitivity and specificity of scales using MINI as a reference standard were found to be maximal at scores ≥5, ≥8 and >11 for PHQ-9, HAM-D, and NDDI-E, respectively. The ROC analysis revealed a statistically significant difference among NDDI-E and PHQ-9 (p = 0.0268). Polytherapy in PWE had significant association with risk of depression (p < 0.01) and female PWE had 1.5 times the odds of depression as compared with males (95% CI, 1.02-2.2). CONCLUSION All the tools used in this study were found to be appropriate for use in PWE if cut-off points are validated. The choice of tool can be based on the clinical setting.
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Affiliation(s)
- Haroon Rashid
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jatinder Katyal
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
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Rashid H, Katyal J, Tripathi M, Sood M, Gupta YK. Validation of the Indian version of Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Epilepsy Behav 2019; 95:75-78. [PMID: 31026787 DOI: 10.1016/j.yebeh.2019.03.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) is an efficient tool for rapid detection of depression, an important comorbid condition in persons with epilepsy (PWE). Since social and cultural differences can potentially affect the cutoff score of NDDI-E, in this study, the reliability and validity of the Indian version of the NDDI-E in PWE was determined. METHOD After ethical clearance, 217 PWE above 18 years of age, on antiepileptic drugs (AEDs), attending neurology outpatient department (OPD) of All India Institute of Medical Sciences (AIIMS), New Delhi, India, were evaluated for depression using the NDDI-E (Indian version) and Mini International Neuropsychiatric Interview (MINI-Module A, version 6.0.0) as reference standard. Informed consent was taken before recruitment. Receiver operating characteristic (ROC) analysis and Cronbach's α, a measure of the internal consistency and reliability, were carried out to validate cutoff and questionnaire, respectively. RESULTS Of the 217 PWE (112 males/105 females), mean age of 28.6 ± 9.4 years, with generalized (69.1%) or focal seizures (30.9%), 41.5% and 10.6% were diagnosed with depression using MINI and NDDI-E Indian version (at cutoff >15), respectively. However, at a cutoff score of >11, the Indian version of NDDI-E had a sensitivity of 96.67%, a specificity of 84.25%, a positive predictive value of 81.31%, and a negative predictive value of 97.27%. ROC analysis showed an area under the curve (AUC) of 0.9547 (confidence interval (CI) 95% = 0.929-0.979; standard error (SE): 0.0127). With the Indian version of NDDI-E, the Cronbach's α value was 0.877. CONCLUSION A periodic assessment of PWE using a quickly administrable and reliable tool for screening depression is highly desirable given the high incidence. In the Indian population with a cutoff of >11, NDDI-E is a reliable and valid instrument to screen depression in PWE.
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Affiliation(s)
- Haroon Rashid
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jatinder Katyal
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Yogendra K Gupta
- Translational Health Science and Technology Institute, Faridabad, Haryana, India
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Jalihal V, Shankar R, Henley W, Parrett M, Tittensor P, McLean BN, Ahmed A, Sander JW. Eslicarbazepine acetate as a replacement for levetiracetam in people with epilepsy developing behavioral adverse events. Epilepsy Behav 2018; 80:365-369. [PMID: 29415871 DOI: 10.1016/j.yebeh.2018.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Psychiatric and behavioral side effects (PBSEs) are a major cause of antiepileptic drug (AED) withdrawal. Levetiracetam (LEV) is a recognized first-line AED with good seizure outcomes but recognized with PBSEs. Eslicarbazepine (ESL) is considered to function similarly to an active metabolite of the commonly used carbamazepine (CBZ). Carbamazepine is used as psychotropic medication to assist in various psychiatric illnesses such as mood disorders, aggression, and anxiety. AIM The aim was to evaluate the psychiatric profile of ESL in people who had LEV withdrawn due to PBSEs in routine clinical practice to see if ESL can be used as a possible alternative to LEV. METHODS A retrospective observational review was conducted in two UK epilepsy centers looking at all cases exposed to ESL since its licensing in 2010. The ESL group was all patients with treatment-resistant epilepsy who developed intolerable PBSEs to LEV, subsequently trialed on ESL. The ESL group was matched to a group who tolerated LEV without intolerable PBSEs. Psychiatric disorders were identified from case notes. The Hamilton Depression Scale (HAM-D) was used to outcome change in mood. Clinical diagnoses of a mental disorder were compared between groups using the Fisher's exact test. Group differences in HAM-D scores were assessed using the independent samples t-test (alpha=0.05). RESULTS The total number of people with active epilepsy in the two centers was 2142 of whom 46 had been exposed to ESL. Twenty-six had previous exposure to LEV and had intolerable PBSEs who were matched to a person tolerating LEV. There was no statistical differences in the two groups for mental disorders including mood as measured by HAM-D (Chi-square test: p=0.28). CONCLUSION The ESL was well tolerated and did not produce significant PBSEs in those who had PBSEs with LEV leading to withdrawal of the drug. Though numbers were small, the findings suggest that ESL could be a treatment option in those who develop PBSEs with LEV and possibly other AEDs.
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Affiliation(s)
- Virupakshi Jalihal
- Ramaiah Medical College and Hospitals, Bengaluru, Karnataka 560054, India
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro TR4 9LD, UK; Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - William Henley
- Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK
| | - Mary Parrett
- Royal Cornwall Hospital, Truro, Cornwall TR1 3LJ, UK
| | | | | | - Ammad Ahmed
- Bial Pharma Ltd., Admiral House, Windsor SL4 3BL, UK
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands
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Fountoulakis KN, Yatham L, Grunze H, Vieta E, Young A, Blier P, Kasper S, Moeller HJ. The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm. Int J Neuropsychopharmacol 2017; 20:121-179. [PMID: 27816941 PMCID: PMC5409012 DOI: 10.1093/ijnp/pyw100] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/29/2016] [Accepted: 11/03/2016] [Indexed: 02/05/2023] Open
Abstract
Background The current paper includes a systematic search of the literature, a detailed presentation of the results, and a grading of treatment options in terms of efficacy and tolerability/safety. Material and Methods The PRISMA method was used in the literature search with the combination of the words 'bipolar,' 'manic,' 'mania,' 'manic depression,' and 'manic depressive' with 'randomized,' and 'algorithms' with 'mania,' 'manic,' 'bipolar,' 'manic-depressive,' or 'manic depression.' Relevant web pages and review articles were also reviewed. Results The current report is based on the analysis of 57 guideline papers and 531 published papers related to RCTs, reviews, posthoc, or meta-analysis papers to March 25, 2016. The specific treatment options for acute mania, mixed episodes, acute bipolar depression, maintenance phase, psychotic and mixed features, anxiety, and rapid cycling were evaluated with regards to efficacy. Existing treatment guidelines were also reviewed. Finally, Tables reflecting efficacy and recommendation levels were created that led to the development of a precise algorithm that still has to prove its feasibility in everyday clinical practice. Conclusions A systematic literature search was conducted on the pharmacological treatment of bipolar disorder to identify all relevant random controlled trials pertaining to all aspects of bipolar disorder and graded the data according to a predetermined method to develop a precise treatment algorithm for management of various phases of bipolar disorder. It is important to note that the some of the recommendations in the treatment algorithm were based on the secondary outcome data from posthoc analyses.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Lakshmi Yatham
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Heinz Grunze
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Eduard Vieta
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Allan Young
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Pierre Blier
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Siegfried Kasper
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Hans Jurgen Moeller
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
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Fountoulakis KN, Gonda X, Baghai TC, Baldwin DS, Bauer M, Blier P, Gattaz W, Hasler G, Möller HJ, Tandon R, Vieta E, Kasper S. Report of the WPA section of pharmacopsychiatry on the relationship of antiepileptic drugs with suicidality in epilepsy. Int J Psychiatry Clin Pract 2015; 19:158-67. [PMID: 25547437 DOI: 10.3109/13651501.2014.1000930] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This report from the World Psychiatric Association Section on Pharmacopsychiatry examines the possible relationship of antiepileptic drugs with suicide-related clinical features and behaviors in patients with epilepsy. MATERIALS AND METHODS A systematic review of the MEDLINE search returned 1039 papers, of which only 8 were considered relevant. A critical analysis of the Food and Drug Administration (FDA) report on the increase risk for patients under antiepileptics to manifest suicidality is also included in this report. RESULTS The analysis of these studies revealed that the data are not supportive of the presence of a "class effect" on suicide-related behavior; on the contrary, there are some data suggesting such an effect concerning treatment with topiramate, lamotrigine, and levetiracetam for which further research is needed. DISCUSSION For the majority of people with epilepsy, anticonvulsant treatment is necessary and its failure for any reason is expected to have deleterious consequences. Therefore, clinicians should inform patients and their families of this increased risk of suicidal ideation and behavior, but should not overemphasize the issue. Specific subgroups of patients with epilepsy might be at a higher risk, and deserve closer monitoring and follow-up. Future research with antiepileptics should specifically focus on depression and suicidal thoughts.
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Abstract
ABSTRACT: Suicidal behavior is not uncommon in epilepsy patients. Risk factors for suicidal ideation are associated with social and vocational disturbances, such as low economic status, lack of social support and unemployment and psychiatric comorbidity. In epilepsy patients, interictal dysphoric disorder presents a depressive mood that may be associated with episodic suicidal ideation. Suicide may occur among patients with very severe epilepsy, but also in patients that recently achieved a complete seizure freedom. Recent research suggests that almost a third of epilepsy patients that endorsed suicidal ideation were euthymic or had only very mild depressive symptoms. People with epilepsy should be specifically asked about their psychiatric problems and potential suicidal ideation. Neurobiology of suicidal behavior in epilepsy patients is still unclear.
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Abstract
OBJECTIVE Suicidal ideation and behavior have been associated with a variety of neurological illnesses. Studies are ongoing in combat veterans and other groups to examine possible mechanisms and pathways that account for such associations. METHOD This article provides a review of the literature on suicide ideation and suicidal behavior in patients with neurological illnesses including publications on veteran's health and military medicine. Studies of suicide attempts and deaths in people with neurological illnesses are also reviewed. RESULTS The studies summarized in this review indicate that there are important linkages between suicidal ideation and behavior and neurological conditions, including epilepsy, multiple sclerosis, and amyotrophic lateral sclerosis. CONCLUSION Additional studies are needed to further clarify why suicide ideation and suicidal behavior are associated with neurological diseases, in order to improve quality of life, alleviate patient distress, and prevent nonfatal and fatal suicide attempts in veteran and non-veteran populations.
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Affiliation(s)
- Steven S Coughlin
- Post-Deployment Health Epidemiology Program, Office of Public Health, Department of Veterans Affairs, Washington, DC, USA
| | - Leo Sher
- James J. Peters Veterans’ Affairs Medical Center, New York, USA
- Mount Sinai School of Medicine, New York, USA
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Pereira A, Gitlin MJ, Gross RA, Posner K, Dworkin RH. Suicidality associated with antiepileptic drugs: implications for the treatment of neuropathic pain and fibromyalgia. Pain 2013; 154:345-349. [PMID: 23375513 DOI: 10.1016/j.pain.2012.12.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 12/28/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Anthony Pereira
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY, USA
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Fountoulakis KN, Gonda X, Samara M, Siapera M, Karavelas V, Ristic DI, Iacovides A. Antiepileptic drugs and suicidality. J Psychopharmacol 2012; 26:1401-7. [PMID: 22402242 DOI: 10.1177/0269881112440514] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current study is a systematic review of the literature concerning the possible relationship of antiepileptics and suicide-related clinical features and behaviours. A MEDLINE search returned 863 papers but only five were chosen as relevant. A critical analysis of the Food and Drug Administration report is also included. Overall, the current review suggests there are no convincing data concerning a 'class effect' of antiepileptics in inducing any type of suicide-related behaviours. Further research is needed concerning topiramate, lamotrigine and maybe leviracetam. Clinicians are expected to inform patients and their families on the possible increased risk but it is important not to overemphasise the issue, since stopping or refusing to start antiepileptics may result in serious harm, including death of the patient. Future randomised controlled trials should specifically focus on issues concerning depression and suicidal thoughts in patients with epilepsy.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 13rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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14
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LaFrance WC, Lancman G, Machan JT, Davis JD, Blum AS. Depression symptoms as a function of duration of intractable or controlled epilepsy. Epilepsy Behav 2012; 24:116-9. [PMID: 22516797 DOI: 10.1016/j.yebeh.2012.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/03/2012] [Accepted: 03/06/2012] [Indexed: 11/28/2022]
Abstract
We examined if depression symptoms in patients with intractable (IE) or controlled epilepsy (CE) differ and how long after onset of epilepsy these effects would be most pronounced. The NDDI-E was administered to all outpatients (n=358) seen in a comprehensive epilepsy program clinic over a two-year period. Patients who met inclusion criteria (n=223) completed a total of 431 NDDI-E surveys over this time. Patients with a diagnosis of IE (n=72) or CE (n=151) were compared as a function of time since their epilepsy onset, segmented into 10-year epochs. Depression symptoms were higher in patients with IE compared to CE at 10-<20 years and did not differ at other time points. This study reveals differences in depression symptoms as a function of duration of epilepsy. Attending to the dynamic nature of depression symptoms in different epochs of epilepsy may be an important treatment target in patients with epilepsy.
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Affiliation(s)
- W Curt LaFrance
- Department of Neurology, Rhode Island Hospital, Providence, RI 02903, USA.
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15
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Garcia CS. Depression in temporal lobe epilepsy: a review of prevalence, clinical features, and management considerations. EPILEPSY RESEARCH AND TREATMENT 2011; 2012:809843. [PMID: 22957244 PMCID: PMC3420378 DOI: 10.1155/2012/809843] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 09/10/2011] [Indexed: 11/17/2022]
Abstract
Depression in temporal lobe epilepsy has been established as a frequent occurrence, and various possible mechanisms for this significant comorbidity have been posited. However, there is still little to guide a clinician in the recognition and management of depression in patients with temporal lobe epilepsy. This is in part due to the lack of consistent findings in earlier studies, which was likely partly due to variabilities in methodology, sampling, and diagnosis of both temporal lobe epilepsy and depression. However, in recent years, significant effort has been made to address these issues and provide a framework for diagnosis and management of depression in this population. The following is a review of the literature, with special emphasis on clinical phenomenology of depressive symptoms, described bidirectional risk between depression and temporal lobe epilepsy, and treatment strategies in the context of potential drug interactions with antiepileptic drugs.
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Affiliation(s)
- C. S. Garcia
- Department of Psychiatry, Schulich School of Medicine, University of Western Ontario, London, ON, Canada N6A 5C1
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16
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Fornaro M, Martino M, Dalmasso B, Colicchio S, Benvenuti M, Rocchi G, Escelsior A, Perugi G. An open pilot study of zonisamide augmentation in major depressive patients not responding to a low dose trial with duloxetine: preliminary results on tolerability and clinical effects. Ann Gen Psychiatry 2011; 10:23. [PMID: 21929762 PMCID: PMC3184102 DOI: 10.1186/1744-859x-10-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 09/19/2011] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite multiple antidepressant options, major depressive disorder (MDD) still faces high non-response rates, eventually requiring anticonvulsant augmentation strategies too. The aim of this study was to explore such a potential role for zonisamide. METHODS A total of 40 MDD outpatients diagnosed using the Diagnostic and Statistical Manual for Mental Disorders, fourth edition criteria entered a 24 week open trial receiving duloxetine 60 mg/day for the first 12 weeks and subsequently (weeks 12 to 24) augmentation with zonisamide 75 mg/day if they did not respond to the initial monotherapy. Efficacy and tolerability were assessed using the Hamilton Scales for Anxiety and Depression (a 12 week score ≥50% vs baseline defined 'non-response'), the Arizona Sexual Experience Scale, the Patient Rated Inventory of Side Effects and the Young Mania Rating Scale. RESULTS At week 12, 15 patients out of 39 (38.5%) were responders, and 1 had dropped out; remarkably, 14 patients out of 24 (58.3%) had achieved response by week 24. Poor concentration and general malaise were associated with non-response both at week 12 and 24 (P = 0.001), while loss of libido and reduced energy were prominent among final timepoint non-responders. Patients receiving zonisamide also experienced weight reduction (2.09 ± 12.14 kg; P = 0.001) independently of the outcome. CONCLUSIONS Although only a preliminary study due to strong methodological limitations, and thus requiring confirmation by further controlled investigations, the current results indicate zonisamide may be a potential augmentation option for some depressed patients receiving low doses of duloxetine.
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Affiliation(s)
- Michele Fornaro
- Department of Neuroscience, Section of Psychiatry, University of Genova, Genoa, Italy.
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Russo E, Citraro R, Scicchitano F, De Fazio S, Perrota I, Di Paola ED, Constanti A, De Sarro G. Effects of early long-term treatment with antiepileptic drugs on development of seizures and depressive-like behavior in a rat genetic absence epilepsy model. Epilepsia 2011; 52:1341-50. [DOI: 10.1111/j.1528-1167.2011.03112.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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