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Mesraoua B, Brigo F, Abou-Khalil B, Ali M, Lattanzi S. Risk of suicide and suicide-related events in subjects treated with antiseizure medications. Expert Rev Neurother 2024; 24:865-878. [PMID: 38978408 DOI: 10.1080/14737175.2024.2376110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION In the United States, it is reported that 1.4% of the general population commits suicide. It has been postulated that antiseizure medications (ASMs) can lead to the development of suicidal ideation and suicidal behavior; however, this risk is still very low and has yet to be precisely established. AREAS COVERED This narrative review evaluates the risk of suicide-related events (SREs) in subjects taking ASMs for various neurological disorders. Screening tools for suicidal ideation and suicidal behavior are also discussed. References for this article were found using PubMed/MEDLINE. EXPERT OPINION Although some ASMs can be associated with SREs, this is not yet clearly established. The mechanisms involved in suicide risk in subjects taking ASMs are multifactorial. The bidirectional relationship between depression and epilepsy, as well as other associations, should be kept in mind when interpreting any impact of ASMs in PWE. Screening for SREs, close monitoring of subjects taking ASMs are the most appropriate strategies to minimize suicide risk. More efforts should be made to achieve accurate risk stratification through prognostic models that could be applied to subjects taking ASMs. Studies exploring the association between ASMs and suicide should consider ASMs individually and control for prior SREs.
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Affiliation(s)
- Boulenouar Mesraoua
- Neurosciences Department, Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | | | - Musab Ali
- Neurosciences Department, Hamad Medical Corporation, Doha, Qatar
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
- Neurological Clinic, AOU of Marche, Ancona, Italy
- Neurology Department, IRCCS INRCA, Ancona, Italy
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Gammoh O, Al-Smadi A, Mansour M, Ennab W, AL Hababbeh S, Al-Taani G, Alsous M, Aljabali AAA, Tambuwala MM. The relationship between psychiatric symptoms and the use of levetiracetam in people with epilepsy. Int J Psychiatry Med 2024; 59:360-372. [PMID: 37837222 PMCID: PMC11044508 DOI: 10.1177/00912174231206056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Background: Mental health in people with epilepsy (PWE) is often overlooked, especially in developing countries.Purpose: Consequently, the current work had two objectives: (1) to estimate the burden of depression, anxiety, insomnia, and stress, and (2) to examine the association of these psychiatric/psychological symptoms with levetiracetam and other relevant clinical factors in a cohort of Jordanian PWE.Research Design: This is a cross-sectional study. The demographic and clinical data were recorded. Depression was measured by the Patient Health Questionnaire-9 (PHQ-9, Arabic-validated version) and anxiety by the General Anxiety Disorder-7 (GAD-7, Arabic-validated version). The insomnia severity index (ISI-A, Arabic version) was used to assess sleep quality, and the Perceived Stress Scale (PSS-A, Arabic version) was used to measure perceived stress.Study Sample: Data were analyzed from 280 patients, of which 178 (63.6%) received levetiracetam as monotherapy or as adjuvant.Results: Depression was reported in 150 (53.6%), anxiety in 110 (39.3%), insomnia in 131 (46.8%), and clinically significant stress in 211 (75.4%). At univariate analysis, levetiracetam was not associated with psychiatric symptoms. Multivariate logistic regression revealed that severe depressive symptoms were associated with family history (OR = 2.47, 95% CI = 1.42-4.33, P = .001) and seizure type (OR = 1.69, 95% CI = 1.01-2.80, P = .04), severe anxiety symptoms were associated with family history (OR = 1.90, 95% CI = 1.12-3.23, P = .01), severe insomnia was associated with seizure type (OR = 2.16, 95% CI = 1.33-3.5, P = .002) and severe stress was associated with marital status (OR = 2.37, 95% CI = 1.31-4.29, P = .004).Conclusions: The high psychological burden of PWE is a challenging issue that requires attention and prompt action to control its risk factors. Levetiracetam was not associated with psychiatric symptoms in this study.
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Affiliation(s)
- Omar Gammoh
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Ahmed Al-Smadi
- Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | | | - Wail Ennab
- Department of Neurology, Al-Bashir Hospital, Amman, Jordan
| | | | - Ghaith Al-Taani
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Mervat Alsous
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Alaa AA Aljabali
- Faculty of Pharmacy, Department of Pharmaceutics and Pharmaceutical Technology, Yarmouk University, Irbid, Jordan
| | - Murtaza M Tambuwala
- Lincoln Medical School, Brayford Pool Campus, University of Lincoln, Lincoln, Lincolnshire, UK
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Chen Y, Li W, Lu C, Gao X, Song H, Zhang Y, Zhao S, Cai G, Guo Q, Zhou D, Chen Y. Efficacy, tolerability and safety of add-on third-generation antiseizure medications in treating focal seizures worldwide: a network meta-analysis of randomised, placebo-controlled trials. EClinicalMedicine 2024; 70:102513. [PMID: 38449838 PMCID: PMC10915785 DOI: 10.1016/j.eclinm.2024.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/08/2024] Open
Abstract
Background Adjunctive newer antiseizure medications (ASMs) are being used in patients with treatment-resistant focal-onset seizures (FOS). An updated network meta-analysis (NMA) was necessary to compile evidence in this critical area. Methods We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus from their inception until 17 January 2024, evaluating the efficacy, tolerability, and safety of rufinamide (RUF), brivaracetam (BRV), cenobamate (CNB), eslicarbazepine (ESL), lacosamide (LCM), retigabine (RTG), and perampanel (PER) as adjunctive treatments for FOS. Efficacy outcomes included seizure response and seizure freedom. Tolerability was assessed by discontinuation due to adverse events (AEs). Safety outcomes were evaluated based on the number of patients experiencing at least one AE and serious adverse events (SAEs). This review is registered with PROSPERO (CRD42023485130). Findings A total of 29 studies involving 11,750 participants were included. For seizure response, all ASMs were significantly superior to placebo, with RTG ranking highest, followed by CNB. Considering dosage, CNB 400 mg/d was top-ranked, followed by RTG 1200 mg/d. For seizure freedom, BRV was highest-ranked, followed by CNB, with BRV 100 mg/d leading, followed by CNB 400 mg/d. Regarding tolerability, LCM 600 mg/d had the lowest ranking, followed by CNB 400 mg/d. For the safety outcome of AEs, ESL 1200 mg/d was ranked lowest, followed by CNB 400 mg/d. Regarding SAEs, LCM 400 mg/d was ranked lowest, followed by RTG 1200 mg/d. Interpretation ASMs at different dosages have varying efficacy and tolerability profiles. We have provided hierarchical rankings of ASMs for efficacy and safety outcomes. Our findings offer the most comprehensive evidence available to inform patients, families, physicians, guideline developers, and policymakers about the choice of ASMs in patients with treatment-resistant FOS. Funding None.
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Affiliation(s)
- Yankun Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Wenze Li
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Chenfei Lu
- Department of Respiratory, The Ninth People's Hospital of Chongqing, Chongqing, 400700, China
| | - Xinxia Gao
- Department of Medical Records, Heze Municipal Hospital, Heze, 274000, China
| | - Huizhen Song
- Department of Neurology, Heze Third People's Hospital, Heze, 274000, China
| | - Yanli Zhang
- Department of Neurology, Shandong Provincial Hospital Heze Branch, Heze, 274000, China
| | - Sihao Zhao
- Department of Neurology, Heze Mudan District People's Hospital, Heze, 274000, China
| | - Gaoang Cai
- Department of Neurology, Juancheng County People's Hospital, Juancheng, 274600, China
| | - Qing Guo
- Department of Neurology, Heze Municipal Hospital Brain Hospital, Heze, 274000, China
| | - Dongdong Zhou
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
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Gasior M, Husain A, Barra ME, Raja SM, MacLeod D, Guptill JT, Vaitkevicius H, Rybak E. Intravenous Ganaxolone: Pharmacokinetics, Pharmacodynamics, Safety, and Tolerability in Healthy Adults. Clin Pharmacol Drug Dev 2024; 13:248-258. [PMID: 38231434 DOI: 10.1002/cpdd.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024]
Abstract
Ganaxolone, a neuroactive steroid anticonvulsant that modulates both synaptic and extrasynaptic γ-aminobutyric acid type A (GABAA ) receptors, is in development for treatment of status epilepticus (SE) and rare epileptic disorders, and has been approved in the United States for treatment of seizures associated with cyclin-dependent kinase-like 5 deficiency disorder in patients ≥2 years old. This phase 1 study in 36 healthy volunteers evaluated the pharmacokinetics, pharmacodynamics, and safety of intravenous ganaxolone administered as a (i) single bolus, (ii) infusion, and (iii) bolus followed by continuous infusion. After a single bolus over 2 minutes (20 mg) or 5 minutes (10 or 30 mg), ganaxolone was detected in plasma with a median Tmax of 5 minutes, whereas a 60-minute infusion (10 or 30 mg) or a bolus (6 mg over 5 minutes) followed by infusion (20 mg/h) for 4 hours achieved a median Tmax of approximately 1 and 3 hours, respectively. Cmax was dose and administration-time dependent, ranging from 73.8 ng/mL (10 mg over 5 minutes) to 1240 ng/mL (30 mg over 5 minutes). Bolus doses above 10 mg of ganaxolone markedly influenced the bispectral index score with a rapid decline; smaller changes occurred on the Modified Observer's Assessment of Alertness/Sedation scale and in quantitative electroencephalogram. Most adverse events were of mild severity, with 2 events of moderate severity; none were reported as serious. No effects on systemic hemodynamics or respiratory functions were reported. Overall, ganaxolone was generally well tolerated at the doses studied and demonstrated pharmacokinetic and pharmacodynamic properties suitable to treat SE.
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Affiliation(s)
| | - Aatif Husain
- Duke University School of Medicine, Durham, NC, USA
| | | | | | | | | | | | - Eva Rybak
- Marinus Pharmaceuticals, Inc., Radnor, PA, USA
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Lemus HN, Villamar MF, Roth J, Tobochnik S. Initiation of Antiseizure Medications by US Board-Certified Neurologists After a First Unprovoked Seizure Based on EEG Findings. Neurol Clin Pract 2024; 14:e200249. [PMID: 38204587 PMCID: PMC10775163 DOI: 10.1212/cpj.0000000000200249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
Background and Objectives To investigate neurologists' practice variability in antiseizure medication (ASM) initiation after a first unprovoked seizure based on reported EEG interpretations. Methods We developed a 15-question multiple-choice survey incorporating a standardized clinical case scenario of a patient with a first unprovoked seizure for whom different EEG reports were provided. The survey was distributed among board-certified neurologists practicing in the United States. Associations between categorical variables were evaluated using the Fisher Exact test. Multivariate analysis was performed using logistic regression. Results A total of 106 neurologists responded to the survey. Most responders (75%-95%) would start ASM for definite epileptiform features on EEG, with similar rates between subgroups differing in years of practice, presence of subspecialty EEG training, and self-reported confidence in EEG interpretation. There was greater variability in practice for nonspecific EEG abnormalities, with sharply contoured activity, sharp transients, and focal delta slowing associated with the highest variability and uncertainty. Neurologists with >5 years of practice experience (21% vs 44%, OR 0.35 [95% CI 0.13-0.89], p = 0.021), subspecialty EEG training (15% vs 50%, OR = 0.17 [95% CI 0.06-0.48], p < 0.001), and greater confidence in EEG interpretation (21% vs 52%, OR 0.24 [95% CI 0.09-0.62], p = 0.001) were less likely to start ASM for ≥2 nonspecific EEG abnormalities and reported greater uncertainty. In multivariate analysis, seniority (p = 0.039) and subspecialty EEG training (p = 0.032) were associated with decreased ASM initiation for nonspecific EEG features. Discussion There was substantial variability in ASM initiation practices between board-certified neurologists after a first unprovoked seizure with nonspecific EEG abnormalities. These findings clarify specific areas where EEG reporting may be optimized and reinforces the importance of implementing evidence-based practice guidelines.
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Affiliation(s)
- Hernan Nicolas Lemus
- Department of Neurology (HNL), The University of Alabama at Birmingham; Department of Neurology (MFV, JR), The Warren Alpert Medical School of Brown University, Providence, RI; and Department of Neurology (ST), Brigham and Women's Hospital, Boston, MA
| | - Mauricio F Villamar
- Department of Neurology (HNL), The University of Alabama at Birmingham; Department of Neurology (MFV, JR), The Warren Alpert Medical School of Brown University, Providence, RI; and Department of Neurology (ST), Brigham and Women's Hospital, Boston, MA
| | - Julie Roth
- Department of Neurology (HNL), The University of Alabama at Birmingham; Department of Neurology (MFV, JR), The Warren Alpert Medical School of Brown University, Providence, RI; and Department of Neurology (ST), Brigham and Women's Hospital, Boston, MA
| | - Steven Tobochnik
- Department of Neurology (HNL), The University of Alabama at Birmingham; Department of Neurology (MFV, JR), The Warren Alpert Medical School of Brown University, Providence, RI; and Department of Neurology (ST), Brigham and Women's Hospital, Boston, MA
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Ruggiero R, Mascolo A, Spezzaferri A, Carpentieri C, Torella D, Sportiello L, Rossi F, Paolisso G, Capuano A. Glucagon-like Peptide-1 Receptor Agonists and Suicidal Ideation: Analysis of Real-Word Data Collected in the European Pharmacovigilance Database. Pharmaceuticals (Basel) 2024; 17:147. [PMID: 38399362 PMCID: PMC10892952 DOI: 10.3390/ph17020147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND A potential risk of suicide associated with liraglutide or semaglutide treatments has recently emerged. Therefore, we decided to investigate the reporting probability of suicidal events among glucagon-like peptide-1 receptor agonists (GLP-1 RAs). METHODS A retrospective pharmacovigilance study of the European Pharmacovigilance database was conducted for the period from 1 January 2018 to 10 July 2023. Disproportionality analyses (reporting odds ratio, ROR) were performed to assess the reporting probability of suicidal events among GLP-1 RAs. RESULTS A total of 230 reports of suicidal events were identified. The most reported GLP-1 RA was liraglutide (38.3%), followed by semaglutide (36.5%) and dulaglutide (16.1%). The most reported events were suicidal ideation (65.3%) and suicide attempt (19.5%). Disproportionality analysis found a higher reporting probability of suicidal events for semaglutide than dulaglutide (ROR, 2.05; 95%CI, 1.40-3.01) and exenatide (ROR, 1.81; 95%CI, 1.08-3.05). In the same way, liraglutide was associated with a higher reporting probability of suicidal events than dulaglutide (ROR, 3.98; 95%CI, 2.73-5.82) and exenatide (ROR, 3.52; 95%CI, 2.10-5.92). On the contrary, a lower reporting probability was found for semaglutide than liraglutide (ROR, 0.51; 95%CI, 0.38-0.69). CONCLUSIONS Suicidal events were mostly reported with semaglutide and liraglutide, which were also associated with significantly higher reporting probabilities compared to other GLP1 RAs. Although this study provides the reporting frequencies of suicide-related events with GLP-1 RAs, establishing causality requires further investigation, which will probably be addressed by the Pharmacovigilance Risk Assessment Committee of the European Medicine Agency in the future.
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Affiliation(s)
- Rosanna Ruggiero
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Napoli, Italy; (R.R.)
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Annamaria Mascolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Napoli, Italy; (R.R.)
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Angela Spezzaferri
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Napoli, Italy; (R.R.)
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Claudia Carpentieri
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Napoli, Italy; (R.R.)
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Daniele Torella
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy;
| | - Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Napoli, Italy; (R.R.)
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Francesco Rossi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Napoli, Italy; (R.R.)
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
- UniCamillus International Medical University, 00131 Rome, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Napoli, Italy; (R.R.)
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
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Zubareva OE, Sinyak DS, Kalita AD, Griflyuk AV, Diespirov GP, Postnikova TY, Zaitsev AV. Antiepileptogenic Effects of Anakinra, Lamotrigine and Their Combination in a Lithium-Pilocarpine Model of Temporal Lobe Epilepsy in Rats. Int J Mol Sci 2023; 24:15400. [PMID: 37895080 PMCID: PMC10607594 DOI: 10.3390/ijms242015400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Temporal lobe epilepsy is a common, chronic disorder with spontaneous seizures that is often refractory to drug therapy. A potential cause of temporal lobe epilepsy is primary brain injury, making prevention of epileptogenesis after the initial event an optimal method of treatment. Despite this, no preventive therapy for epilepsy is currently available. The purpose of this study was to evaluate the effects of anakinra, lamotrigine, and their combination on epileptogenesis using the rat lithium-pilocarpine model of temporal lobe epilepsy. The study showed that there was no significant difference in the number and duration of seizures between treated and untreated animals. However, the severity of seizures was significantly reduced after treatment. Anakinra and lamotrigine, alone or in combination, significantly reduced neuronal loss in the CA1 hippocampus compared to the control group. However, the drugs administered alone were found to be more effective in preventing neuron loss in the hippocampal CA3 field compared to combination treatment. The treatment alleviated the impairments in activity level, exploratory behavior, and anxiety but had a relatively weak effect on TLE-induced impairments in social behavior and memory. The efficacy of the combination treatment did not differ from that of anakinra and lamotrigine monotherapy. These findings suggest that anakinra and lamotrigine, either alone or in combination, may be clinically useful in preventing the development of histopathological and behavioral abnormalities associated with epilepsy.
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Affiliation(s)
| | | | | | | | | | | | - Aleksey V. Zaitsev
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, 194223 Saint Petersburg, Russia; (O.E.Z.); (D.S.S.); (A.D.K.); (A.V.G.); (G.P.D.); (T.Y.P.)
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Tomson T, Zelano J, Dang YL, Perucca P. The pharmacological treatment of epilepsy in adults. Epileptic Disord 2023; 25:649-669. [PMID: 37386690 DOI: 10.1002/epd2.20093] [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: 05/03/2023] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 07/01/2023]
Abstract
The pharmacological treatment of epilepsy entails several critical decisions that need to be based on an individual careful risk-benefit analysis. These include when to initiate treatment and with which antiseizure medication (ASM). With more than 25 ASMs on the market, physicians have opportunities to tailor the treatment to individual patients´ needs. ASM selection is primarily based on the patient's type of epilepsy and spectrum of ASM efficacy, but several other factors must be considered. These include age, sex, comorbidities, and concomitant medications to mention the most important. Individual susceptibility to adverse drug effects, ease of use, costs, and personal preferences should also be taken into account. Once an ASM has been selected, the next step is to decide on an individual target maintenance dose and a titration scheme to reach this dose. When the clinical circumstances permit, a slow titration is generally preferred since it is associated with improved tolerability. The maintenance dose is adjusted based on the clinical response aiming at the lowest effective dose. Therapeutic drug monitoring can be of value in efforts to establish the optimal dose. If the first monotherapy fails to control seizures without significant adverse effects, the next step will be to gradually switch to an alternative monotherapy, or sometimes to add another ASM. If an add-on is considered, combining ASMs with different modes of action is usually recommended. Misdiagnosis of epilepsy, non-adherence and suboptimal dosing are frequent causes of treatment failure and should be excluded before a patient is regarded as drug-resistant. Other treatment modalities, including epilepsy surgery, neuromodulation, and dietary therapies, should be considered for truly drug-resistant patients. After some years of seizure freedom, the question of ASM withdrawal often arises. Although successful in many, withdrawal is also associated with risks and the decision needs to be based on careful risk-benefit analysis.
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Affiliation(s)
- Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johan Zelano
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Gothenburg, Sweden
| | - Yew Li Dang
- Bladin-Berkovic Comprehensive Epilepsy Program, Austin Health, Melbourne, Victoria, Australia
- Epilepsy Research Centre, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia
| | - Piero Perucca
- Bladin-Berkovic Comprehensive Epilepsy Program, Austin Health, Melbourne, Victoria, Australia
- Epilepsy Research Centre, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
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Mula M. Impact of psychiatric comorbidities on the treatment of epilepsies in adults. Expert Rev Neurother 2023; 23:895-904. [PMID: 37671683 DOI: 10.1080/14737175.2023.2250558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Epilepsy is often accompanied by psychiatric comorbidities and the management of epilepsy in these patients presents unique challenges due to the interplay between the underlying neurological condition and the psychiatric symptoms and the combined use of multiple medications. AREAS COVERED This paper aims to explore the complexities associated with managing epilepsy in the presence of psychiatric comorbidities, focusing on the impact of psychiatric disorders on epilepsy treatment strategies and the challenges posed by the simultaneous administration of multiple medications. EXPERT OPINION Patients with epilepsy and psychiatric comorbidities seem to present with a more severe form of epilepsy that is resistant to drug treatments and burdened by an increased morbidity and mortality. Whether prompt treatment of psychiatric disorders can influence the long-term prognosis of the epilepsy is still unclear as well as the role of specific treatment strategies, such as neuromodulation, in this group of patients. Clinical practice recommendations and guidelines will prompt the development of new models of integrated care to be implemented.
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Affiliation(s)
- Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospital, London, UK of Great Britain and Northern Ireland
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
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Leppien EE, Doughty BJ, Hurd KL, Strong KN, Piper BJ, McCall KL. Newer Antiseizure Medications and Suicidality: Analysis of the Food and Drug Administration Adverse Event Reporting System (FAERS) Database. Clin Drug Investig 2023:10.1007/s40261-023-01272-9. [PMID: 37184612 DOI: 10.1007/s40261-023-01272-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The association between antiseizure medications (ASMs) and suicidality remains controversial. Analyses of additional datasets are needed to further elucidate the complex relationship between antiseizure medications and suicidality. OBJECTIVE The aim of this study was to compare the safety profile of newer ASMs with older ASMs through an analysis of the US Food and Drug Administration Adverse Event Reporting System (FAERS) database, with a focus on suicidality. METHODS We queried over 17 million reports in the FAERS database from 2012 to 2021 and identified cases involving ASMs. After removing incomplete and duplicate reports, the study cohort consisted of lacosamide (n = 7593), perampanel (n = 1813), clobazam (n = 3827), brivaracetam (n = 1166), and vigabatrin (n = 5293) compared with a control group of older ASMs (topiramate, lamotrigine, valproic acid, carbamazepine, levetiracetam; n = 71,535). Cases of suicidality (completed suicide, suicidal ideation, attempted suicide, suicidal behavior, suicidal depression) were identified in each group. Adjusted (age and sex) odds ratios (aOR) and associated 95% confidence intervals (CI) were calculated using logistic regression analysis for each new drug when compared with the control group of older ASM drugs. RESULTS A total of 6309 cases of suicidality were identified among reports with ASMs. Most reports were sourced from healthcare professionals (5516, 87.4%). The proportion of reports involving suicidality were 210/7593 (2.8%) for lacosamide, 185/1813 (10.2%) for perampanel, 108/3827 (2.8%) for clobazam, 57/1166 (4.9%) for brivaracetam, 14/5293 (0.3%) for vigabatrin, and 5735/71,535 (8.0%) for older ASMs. Compared with older ASMs, the aOR for suicidality was 0.33 (95% CI 0.28-0.38) for lacosamide, 1.34 (95% CI 1.15-1.56) for perampanel, 0.35 (95% CI 0.29-0.43) for clobazam, 0.60 (95% CI 0.45-0.77) for brivaracetam, and 0.03 (95% CI 0.02-0.05) for vigabatrin. CONCLUSION When compared with older ASMs, four newer ASMs (lacosamide, clobazam, brivaracetam, and vigabatrin) were found to have significantly lower odds of suicidality, while perampanel was found to significantly increase the odds of suicidality. Pronounced variability (greater than 30 fold) in the proportion of FAERS reports associated with suicidality among the drugs studied was identified. The results of this case control study of FDA adverse event reports spanning 10 years and 6309 cases of suicidality expand our understanding of the safety profile of newer ASMs.
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Affiliation(s)
- Emily E Leppien
- Department of Pharmacy Practice, Binghamton University School of Pharmacy & Pharmaceutical Sciences, Johnson City, NY, 13790, USA
| | - Bennett J Doughty
- Department of Pharmacy Practice, Binghamton University School of Pharmacy & Pharmaceutical Sciences, Johnson City, NY, 13790, USA
| | - Karyssa L Hurd
- Binghamton University School of Pharmacy & Pharmaceutical Sciences, 96 Corliss Avenue, Johnson City, NY, 13790, USA
| | - Keira N Strong
- Binghamton University School of Pharmacy & Pharmaceutical Sciences, 96 Corliss Avenue, Johnson City, NY, 13790, USA
| | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, 18510, USA
- Geisinger Center for Pharmacy Innovation and Outcomes, Daville, PA, 17821, USA
| | - Kenneth L McCall
- Department of Pharmacy Practice, Binghamton University School of Pharmacy & Pharmaceutical Sciences, Johnson City, NY, 13790, USA.
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11
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Pisani F, Pisani LR, Barbieri MA, de Leon J, Spina E. Optimization of Therapy in Patients with Epilepsy and Psychiatric Comorbidities: Key Points. Curr Neuropharmacol 2023; 21:1755-1766. [PMID: 35619263 PMCID: PMC10514544 DOI: 10.2174/1570159x20666220526144314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/24/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022] Open
Abstract
Psychiatric disorder comorbidity in patients with epilepsy (PWE) is very frequent with a mean percentage prevalence of up to 50% and even higher. Such a high frequency suggests that epilepsy and psychiatric disorders might share common pathological pathways. Various aspects contribute in making the matter very complex from a therapeutic point of view. Some antiseizure medications (ASMs), namely valproic acid, carbamazepine, and lamotrigine, have mood-stabilising effects and are routinely used for the treatment of bipolar disorder in patients who do not have epilepsy. Pregabalin and, to a lesser extent, gabapentin, exerts anxiolytic effects. However, several ASMs, in particular levetiracetam, topiramate, and perampanel, may contribute to psychiatric disorders, including depression, aggressive behaviour, and even psychosis. If these ASMs are prescribed, the patient should be monitored closely. A careful selection should be made also with psychotropic drugs. Although most of these can be safely used at therapeutic doses, bupropion, some tricyclic antidepressants, maprotiline, and clozapine may alter seizure threshold and facilitate epileptic seizures. Interactions between ASMs and psychotropic medication may make it difficult to predict individual response. Pharmacokinetic interactions can be assessed with drug monitoring and are consequently much better documented than pharmacodynamic interactions. Another aspect that needs a careful evaluation is patient adherence to treatment. Prevalence of non-adherence in PWE and psychiatric comorbidities is reported to reach values even higher than 70%. A careful evaluation of all these aspects contributes in optimizing therapy with a positive impact on seizure control, psychiatric wellbeing, and quality of life.
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Affiliation(s)
- Francesco Pisani
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | | | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA and Psychiatry and Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Italy
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12
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Wang H, Zhang Y, Tan G, Chen D, Fu Y, Liu L. Suicidality and epilepsy: A systematic review and meta-analysis. Front Psychiatry 2023; 14:1097516. [PMID: 37065883 PMCID: PMC10090680 DOI: 10.3389/fpsyt.2023.1097516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 04/18/2023] Open
Abstract
Background We aimed to evaluate the association between epilepsy and suicidality, including suicidal ideation, attempts and completed suicide. Methods We systematically searched PubMed, Embase, Cochrane Online Library, and Clinicaltrials.gov from 1946 to June 21, 2021 and assessed the quality of the studies using the Newcastle-Ottawa Scale. We calculated the pooled OR and the crude rate for suicidal ideation, suicide attempts and completed suicide in patients with epilepsy (PWE). Results We screened 2,786 studies and included 88 articles with 1,178,401 PWE and 6,900,657 participants as controls. Search terms included epilepsy and suicide. The pooled rates of suicidal ideation, suicide attempts and completed suicide in PWE were 19.73% (95% CI: 17.00-22.62%), 5.96% (95% CI: 4.82-7.20%), and 0.24% (95% CI: 0.11-0.42%), respectively. Compared to the control group, PWE were at a significantly higher risk of total suicidality (pooled OR, 2.60; 95%: 2.13-3.18), including suicidal ideation (pooled OR, 2.70; 95% CI, 2.21-3.30), suicide attempts (pooled OR, 2.74; 95% CI, 2.08-3.61) and completed suicide (pooled OR, 2.36; 95% CI, 1.45-3.83). Subgroup analyses showed significant differences in the subgroups of the measurement of suicidality. Conclusion The rate of suicidal ideation, suicide attempts and completed suicide in PWE were about 19.73, 5.96, and 0.24%. And there was an increased risk of suicidality in PWE especially temporal lobe epilepsy and drug-resistant epilepsy. Clinicians need to be aware of this risk in PWE with early identification and prevention at the time of diagnosis.Protocol Registration: PROSPERO CRD42021278220.
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Affiliation(s)
- Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha City, China
| | - Yu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, China
| | - Ge Tan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Deng Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaoqi Fu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ling Liu,
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13
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Tedrus GMDAS, Souza DDCMD. I would be better off dead: investigating suicidal ideation in people with epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:718-724. [PMID: 36254445 PMCID: PMC9685829 DOI: 10.1055/s-0042-1755230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND It is known that the risk of suicidal behavior in adult people with epilepsy (PWEs) is high. However, the associated clinical and psychosocial factors are still being discussed. OBJECTIVE To assess the risk of suicide in PWEs and relate it to resilience and quality of life (QoL) as well as with clinical variables. METHODS The item "I'd be better off dead" of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) was related to the resilience scale, clinical aspects, the presence of depression, and the Quality of Life in Epilepsy Inventory (QOLIE-31) scores of PWEs, with a p < 0.05. RESULTS A total of 271 PWEs were assessed, 50.6% were female, with a mean age of 46.6 (± 15.8) years, and a mean age at 1st seizure of 24.1 (± 18.5) years. Risk for suicide occurred in 50 (19.3%) cases. In multiple logistic regression, the factors that explain the risk of suicide were female sex, depression, and lower scores on the QOLIE-31 and on the resilience scale. In the classification and regression trees, the order of importance of the variables was depression > resilience > age > QoL > age at 1st seizure. CONCLUSION The risk of suicide was high, and it was associated with demographic aspects, clinical variables, QoL, and resilience. A higher risk of suicide was associated with lower resilience regardless of the presence or absence of depression. In the presence of depression, a higher risk of suicide was associated with the early onset of epilepsy. In the absence of depression, the risk of suicide was associated with low QoL in young adults.
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14
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Ruggiero RN, Peixoto-Santos JE, Bueno-Junior LS, Valente KD, Leite JP. Editorial: Psychiatric Comorbidities in the Epilepsies: Extensive Mechanisms and Broad Questions. Front Integr Neurosci 2022; 16:951170. [PMID: 35784497 PMCID: PMC9249385 DOI: 10.3389/fnint.2022.951170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rafael Naime Ruggiero
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
- *Correspondence: Rafael Naime Ruggiero
| | - Jose Eduardo Peixoto-Santos
- Neuroscience Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Kette D. Valente
- Institute and Department of Psychiatry, Faculty of Medicine of the University of São Paulo (HCFMUSP), São Paulo, Brazil
| | - Joao Pereira Leite
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
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15
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Abstract
INTRODUCTION Almost 15 years after the Food and Drug Administration (FDA) issued an alert about an increased suicidality risk with antiseizure medications (ASMs), there is still considerable debate on this subject. AREAS COVERED This is a review of the role of ASMs in the context of suicide in epilepsy. EXPERT OPINION After an explosion of research shortly after the FDA warning was released, only a limited number of studies were published in more recent years and they did not overcome the limitations of previous studies. Overall, available literature does not support an obvious causal relationship between ASMs and suicide. On the contrary, studies are highlighting the complex relationship between suicide and epilepsy, strengthening the bidirectional relationship and the multifactorial origin.
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Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK
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16
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Mula M, Coleman H, Wilson SJ. Neuropsychiatric and Cognitive Comorbidities in Epilepsy. Continuum (Minneap Minn) 2022; 28:457-482. [PMID: 35393966 DOI: 10.1212/con.0000000000001123] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article discusses psychiatric and cognitive comorbidities of epilepsy over the lifespan and illustrates opportunities to improve the quality of care of children and adults with epilepsy. RECENT FINDINGS One in 3 people with epilepsy have a lifetime history of psychiatric disorders, and they represent an important prognostic marker of epilepsy. Contributors are diverse and display a complex relationship. Cognitive comorbidities are also common among those living with epilepsy and are increasingly recognized as a reflection of changes to underlying brain networks. Among the cognitive comorbidities, intellectual disability and dementia are common and can complicate the diagnostic process when cognitive and/or behavioral features resemble seizures. SUMMARY Comorbidities require consideration from the first point of contact with a patient because they can determine the presentation of symptoms, responsiveness to treatment, and the patient's day-to-day functioning and quality of life. In epilepsy, psychiatric and cognitive comorbidities may prove a greater source of disability for the patient and family than the seizures themselves, and in the case of essential comorbidities, they are regarded as core to the disorder in terms of etiology, diagnosis, and treatment.
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Edward F. Suicidality: Once Again, Don’t Blame the Drug Class. Epilepsy Curr 2021. [PMCID: PMC8832346 DOI: 10.1177/15357597211053193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Importance Mostantiseizure medications (ASMs) carry a US Food and Drug Administration–mandated class label warning of increased suicidality risk, based on a meta-analysis comparing suicidality between individuals treated with medications vs placebo in randomized clinical trials done before 2008. ASMs approved since then carry this warning although they were not similarly studied. Objective To review all placebo-controlled phase 2 and 3 studies of 10 ASMs approved since 2008 to evaluate the risk of suicidality of these drugs compared with placebo. Data Sources Primary publications and secondary safety analyses in PubMed of all phase 2 and 3 randomized placebo-controlled epilepsy trials of ASMs approved since 2008, using keywords epilepsy, antiepileptic drugs, seizures, suicidality, suicidal ideation, and the names of individual drugs. Study Selection All phase 2 and 3 randomized clinical trials of adjunctive treatment of drug-resistant epilepsy and their secondary safety analyses. Data Extraction and Synthesis Articles were reviewed for frequency of suicidality (ideation, attempts, and completed suicides). Mode of suicidality ascertainment included treatment-emergent adverse event reports, Standardized Medical Dictionary for Regulatory Activities queries for events in prespecified categories including suicidal ideation and behavior, prospective collection of suicidality data as a prespecified safety outcome using the Columbia-Suicide Severity Rating Scale, and retrospective evaluation by blinded review using the Columbia-Classification Algorithm of Suicide Assessment. A meta-analysis compared risk for drugs vs placebo of each outcome for all drugs overall and by individual drugs and trials. Main Outcomes and Measures Suicidality (total and by ideation), attempts, and completed suicides. Results Excluding studies that did not evaluate suicidality (everolimus and fenfluramine) or did not evaluate it prospectively (lacosamide, ezogabine, and clobazam), 5 drugs were analyzed: eslicarbazepine, perampanel, brivaracetam, cannabidiol, and cenobamate. Suicidality was evaluated in 17 randomized clinical trials of these drugs, involving 5996 patients, of whom 4000 patients were treated with ASMs and 1996 with placebo. There was no evidence of increased risk of suicidal ideation (drugs vs placebo overall risk ratio, .75; 95% CI, .35–1.60) or attempt (risk ratio, .75; 95% CI, .30–1.87) overall or for any individual drug. Suicidal ideation occurred in 12 of 4000 patients treated with ASMs (.30%) vs 7 of 1996 patients treated with placebo (.35%) ( P = .74). Three patients treated with ASMs and no patients treated with placebo attempted suicide ( P = .22). There were no completed suicides. Conclusions and Relevance There is no current evidence that the 5 ASMs evaluated in this study increase suicidality in epilepsy and merit a suicidality class warning
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18
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Kløvgaard M, Lynge TH, Tsiropoulos I, Uldall PV, Banner J, Winkel BG, Ryvlin P, Tfelt-Hansen J, Sabers A. Comparing Seizure-Related Death and Suicide in Younger Adults with Epilepsy. Ann Neurol 2021; 90:983-987. [PMID: 34564866 DOI: 10.1002/ana.26227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/02/2021] [Accepted: 09/19/2021] [Indexed: 01/21/2023]
Abstract
Younger adults with epilepsy have an increased mortality. Some deaths are seizure-related, for example, sudden unexpected death in epilepsy (SUDEP), whereas others, for example, suicide, have multiple causes, including adverse effects of the treatment on mood. In this retrospective population-based study of all Danish persons with epilepsy aged 18 to 49 years during 2007 to 2009 we evaluated the risk of death from seizures and suicide. SUDEP comprised 82.7% of all seizure-related death. Younger adults with epilepsy had an 8.3-fold increased risk of death from seizure-related causes compared with suicide. This underpins the importance of effective seizure control in preventing premature death. ANN NEUROL 2021.
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Affiliation(s)
- Marius Kløvgaard
- The Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Thomas H Lynge
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Ioannis Tsiropoulos
- The Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Peter V Uldall
- The Neuropediatric Clinic, Department of Pediatrics, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark.,Danish Epilepsy Centre, Dianalund, Denmark
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo G Winkel
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Philippe Ryvlin
- Service de Neurologie, Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jacob Tfelt-Hansen
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark.,Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Sabers
- The Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
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19
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Klein P, Devinsky O, French J, Harden C, Krauss GL, McCarter R, Sperling MR. Suicidality Risk of Newer Antiseizure Medications: A Meta-analysis. JAMA Neurol 2021; 78:1118-1127. [PMID: 34338718 DOI: 10.1001/jamaneurol.2021.2480] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Most antiseizure medications (ASMs) carry a US Food and Drug Administration-mandated class label warning of increased suicidality risk, based on a meta-analysis comparing suicidality between individuals treated with medications vs placebo in randomized clinical trials done before 2008. ASMs approved since then carry this warning although they were not similarly studied. Objective To review all placebo-controlled phase 2 and 3 studies of 10 ASMs approved since 2008 to evaluate the risk of suicidality of these drugs compared with placebo. Data Sources Primary publications and secondary safety analyses in PubMed of all phase 2 and 3 randomized placebo-controlled epilepsy trials of ASMs approved since 2008, using keywords epilepsy, antiepileptic drugs, seizures, suicidality, suicidal ideation, and the names of individual drugs. Study Selection All phase 2 and 3 randomized clinical trials of adjunctive treatment of drug-resistant epilepsy and their secondary safety analyses. Data Extraction and Synthesis Articles were reviewed for frequency of suicidality (ideation, attempts, and completed suicides). Mode of suicidality ascertainment included treatment-emergent adverse event reports, Standardized Medical Dictionary for Regulatory Activities queries for events in prespecified categories including suicidal ideation and behavior, prospective collection of suicidality data as a prespecified safety outcome using the Columbia-Suicide Severity Rating Scale, and retrospective evaluation by blinded review using the Columbia-Classification Algorithm of Suicide Assessment. A meta-analysis compared risk for drugs vs placebo of each outcome for all drugs overall and by individual drugs and trials. Main Outcomes and Measures Suicidality (total and by ideation), attempts, and completed suicides. Results Excluding studies that did not evaluate suicidality (everolimus and fenfluramine) or did not evaluate it prospectively (lacosamide, ezogabine, and clobazam), 5 drugs were analyzed: eslicarbazepine, perampanel, brivaracetam, cannabidiol, and cenobamate. Suicidality was evaluated in 17 randomized clinical trials of these drugs, involving 5996 patients, of whom 4000 patients were treated with ASMs and 1996 with placebo. There was no evidence of increased risk of suicidal ideation (drugs vs placebo overall risk ratio, 0.75; 95% CI, 0.35-1.60) or attempt (risk ratio, 0.75; 95% CI, 0.30-1.87) overall or for any individual drug. Suicidal ideation occurred in 12 of 4000 patients treated with ASMs (0.30%) vs 7 of 1996 patients treated with placebo (0.35%) (P = .74). Three patients treated with ASMs and no patients treated with placebo attempted suicide (P = .22). There were no completed suicides. Conclusions and Relevance There is no current evidence that the 5 ASMs evaluated in this study increase suicidality in epilepsy and merit a suicidality class warning.
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Affiliation(s)
- Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland
| | - Orrin Devinsky
- NYU Langone School of Medicine, Department of Neurology, New York, New York
| | - Jacqueline French
- NYU Langone School of Medicine, Department of Neurology, New York, New York
| | - Cynthia Harden
- Xenon Pharmaceuticals, Burnaby, British Columbia, Canada
| | - Gregory L Krauss
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, Maryland
| | - Robert McCarter
- Children's National Medical Center, Bioinformatics, Washington, DC
| | - Michael R Sperling
- Thomas Jefferson University, Department of Neurology, Philadelphia, Pennsylvania
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20
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Gurgu RS, Ciobanu AM, Danasel RI, Panea CA. Psychiatric comorbidities in adult patients with epilepsy (A systematic review). Exp Ther Med 2021; 22:909. [PMID: 34249153 PMCID: PMC8264824 DOI: 10.3892/etm.2021.10341] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023] Open
Abstract
The co-occurrence of epilepsy and psychiatric disorders is long known. The scope of this systematic review was to describe the prevalence of specific interictal psychiatric disorders in patients with epilepsy and to assess possible associations between psychiatric disorders and other sociodemographic or clinical characteristics of epilepsy patients. MEDLINE and ScienceDirect were searched for original articles published between January 2015 and February 2021 describing studies that involved epilepsy patients with psychiatric comorbidities. We identified 13 studies with heterogenous methodology and reporting. Prevalence of any psychiatric disorder observed was up to 51% in idiopathic generalized epilepsy (IGE), up to 43.1% in temporal lobe epilepsy (TLE) and up to 43.3% in a general population of patients with epilepsy. The most frequent psychiatric comorbidities associated with epilepsy included mood/affective disorders (up to 40% for lifetime occurrence and up to 23% for current occurrence), anxiety disorders (up to 30.8% for lifetime occurrence and up to 15.6% for current occurrence), personality disorders [up to 11% in juvenile myoclonic epilepsy (JME)] and psychotic disorders (up to 4% of epilepsy patients). In focal epilepsy, depressive disorders might be associated with specific brain imaging findings and with cognitive impairment. Anxiety disorders are associated with a higher frequency of generalized tonico-clonic seizure (GTCS) and with worse social functioning. Psychotic disorders were found to be associated with longer duration of epilepsy. Childhood maltreatment experiences were found to be a powerful predictor for the occurrence of psychiatric comorbidities in epilepsy patients, while data regarding association of other epilepsy characteristics with the presence of psychiatric disorders is conflicting.
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Affiliation(s)
- Raluca Simona Gurgu
- Neurology Department, 'Elias' University Hospital of Emergency, 011461 Bucharest, Romania
| | - Adela Magdalena Ciobanu
- Neurosciences Department, Discipline of Psychiatry, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Psychiatry, 'Prof. Dr. Alexandru Obregia' Clinical Psychiatric Hospital, 041914 Bucharest, Romania
| | - Roxana Ionela Danasel
- Department of Psychiatry, 'Prof. Dr. Alexandru Obregia' Clinical Psychiatric Hospital, 041914 Bucharest, Romania
| | - Cristina Aura Panea
- Neurology Department, 'Elias' University Hospital of Emergency, 011461 Bucharest, Romania.,Neurosciences Department, Discipline of Neurology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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21
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Abstract
BACKGROUND Depressive disorders are the most common psychiatric comorbidity in people with epilepsy, affecting around one-third, with a significant negative impact on quality of life. There is concern that people may not be receiving appropriate treatment for their depression because of uncertainty regarding which antidepressant or class works best, and the perceived risk of exacerbating seizures. This review aimed to address these issues, and inform clinical practice and future research. This is an updated version of the original Cochrane Review published in Issue 12, 2014. OBJECTIVES To evaluate the efficacy and safety of antidepressants in treating depressive symptoms and the effect on seizure recurrence, in people with epilepsy and depression. SEARCH METHODS For this update, we searched CRS Web, MEDLINE, SCOPUS, PsycINFO, and ClinicalTrials.gov (February 2021). We searched the World Health Organization Clinical Trials Registry in October 2019, but were unable to update it because it was inaccessible. There were no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) and prospective non-randomised studies of interventions (NRSIs), investigating children or adults with epilepsy, who were treated with an antidepressant and compared to placebo, comparative antidepressant, psychotherapy, or no treatment for depressive symptoms. DATA COLLECTION AND ANALYSIS: The primary outcomes were changes in depression scores (proportion with a greater than 50% improvement, mean difference, and proportion who achieved complete remission) and change in seizure frequency (mean difference, proportion with a seizure recurrence, or episode of status epilepticus). Secondary outcomes included the number of participants who withdrew from the study and reasons for withdrawal, quality of life, cognitive functioning, and adverse events. Two review authors independently extracted data for each included study. We then cross-checked the data extraction. We assessed risk of bias using the Cochrane tool for RCTs, and the ROBINS-I for NRSIs. We presented binary outcomes as risk ratios (RRs) with 95% confidence intervals (CIs) or 99% CIs for specific adverse events. We presented continuous outcomes as standardised mean differences (SMDs) with 95% CIs, and mean differences (MDs) with 95% CIs. MAIN RESULTS: We included 10 studies in the review (four RCTs and six NRSIs), with 626 participants with epilepsy and depression, examining the effects of antidepressants. One RCT was a multi-centre study comparing an antidepressant with cognitive behavioural therapy (CBT). The other three RCTs were single-centre studies comparing an antidepressant with an active control, placebo, or no treatment. The NRSIs reported on outcomes mainly in participants with focal epilepsy before and after treatment for depression with a selective serotonin reuptake inhibitor (SSRI); one NRSI compared SSRIs to CBT. We rated one RCT at low risk of bias, three RCTs at unclear risk of bias, and all six NRSIs at serious risk of bias. We were unable to conduct any meta-analysis of RCT data due to heterogeneity of treatment comparisons. We judged the certainty of evidence to be moderate to very low across comparisons, because single studies contributed limited outcome data, and because of risk of bias, particularly for NRSIs, which did not adjust for confounding variables. More than 50% improvement in depressive symptoms ranged from 43% to 82% in RCTs, and from 24% to 97% in NRSIs, depending on the antidepressant given. Venlafaxine improved depressive symptoms by more than 50% compared to no treatment (mean difference (MD) -7.59 (95% confidence interval (CI) -11.52 to -3.66; 1 study, 64 participants; low-certainty evidence); the results between other comparisons were inconclusive. Two studies comparing SSRIs to CBT reported inconclusive results for the proportion of participants who achieved complete remission of depressive symptoms. Seizure frequency data did not suggest an increased risk of seizures with antidepressants compared to control treatments or baseline. Two studies measured quality of life; antidepressants did not appear to improve quality of life over control. No studies reported on cognitive functioning. Two RCTs and one NRSI reported comparative data on adverse events; antidepressants did not appear to increase the severity or number of adverse events compared to controls. The NSRIs reported higher rates of withdrawals due to adverse events than lack of efficacy. Reported adverse events for antidepressants included nausea, dizziness, sedation, headache, gastrointestinal disturbance, insomnia, and sexual dysfunction. AUTHORS' CONCLUSIONS: Existing evidence on the effectiveness of antidepressants in treating depressive symptoms associated with epilepsy is still very limited. Rates of response to antidepressants were highly variable. There is low certainty evidence from one small RCT (64 participants) that venlafaxine may improve depressive symptoms more than no treatment; this evidence is limited to treatment between 8 and 16 weeks, and does not inform longer-term effects. Moderate to low evidence suggests neither an increase nor exacerbation of seizures with SSRIs. There are no available comparative data to inform the choice of antidepressant drug or classes of drug for efficacy or safety for treating people with epilepsy and depression. RCTs of antidepressants utilising interventions from other treatment classes besides SSRIs, in large samples of patients with epilepsy and depression, are needed to better inform treatment policy. Future studies should assess interventions across a longer treatment duration to account for delayed onset of action, sustainability of treatment responses, and to provide a better understanding of the impact on seizure control.
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Affiliation(s)
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Sarah J Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
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Gandy M, Modi AC, Wagner JL, LaFrance WC, Reuber M, Tang V, Valente KD, Goldstein LH, Donald KA, Rayner G, Michaelis R. Managing depression and anxiety in people with epilepsy: A survey of epilepsy health professionals by the ILAE Psychology Task Force. Epilepsia Open 2021; 6:127-139. [PMID: 33681656 PMCID: PMC7918327 DOI: 10.1002/epi4.12455] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/09/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023] Open
Abstract
Objectives The Psychology Task Force of the Medical Therapies Commission of the International League Against Epilepsy (ILAE) has been charged with taking steps to improve global mental health care for people with epilepsy. This study aimed to inform the direction and priorities of the Task Force by examining epilepsy healthcare providers' current practical experiences, barriers, and unmet needs around addressing depression and anxiety in their patients. Methods A voluntary 27-item online survey was distributed via ILAE chapters and networks. It assessed practices in the areas of screening, referral, management, and psychological care for depression and anxiety. A total of 445 participants, from 67 countries (68% high income), commenced the survey, with 87% completing all components. Most respondents (80%) were either neurologists or epileptologists. Results Less than half of respondents felt adequately resourced to manage depression and anxiety. There was a lack of consensus about which health professionals were responsible for screening and management of these comorbidities. About a third only assessed for depression and anxiety following spontaneous report and lack of time was a common barrier (>50%). Routine referrals to psychiatrists (>55%) and psychologists (>41%) were common, but approximately one third relied on watchful waiting. A lack of both trained mental health specialists (>55%) and standardized procedures (>38%) was common barriers to referral practices. The majority (>75%) of respondents' patients identified with depression or anxiety had previously accessed psychotropic medications or psychological treatments. However, multiple barriers to psychological treatments were endorsed, including accessibility difficulties (52%). Significance The findings suggest that while the importance of managing depression and anxiety in patients with epilepsy is being recognized, there are ongoing barriers to effective mental health care. Key future directions include the need for updated protocols in this area and the integration of mental health professionals within epilepsy settings.
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Affiliation(s)
- Milena Gandy
- The eCentreClinicDepartment of PsychologyFaculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyAustralia
| | - Avani C. Modi
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children’s Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Janelle L. Wagner
- College of NursingMedical University of South CarolinaCharlestonSCUSA
| | - W. Curt LaFrance
- Departments of Psychiatry and NeurologyRhode Island HospitalBrown UniversityProvidenceRIUSA
| | - Markus Reuber
- Academic Neurology UnitRoyal Hallamshire HospitalUniversity of SheffieldSheffieldUK
| | - Venus Tang
- Department of Clinical PsychologyPrince of Wales Hospital, Hospital AuthoritySha TinHong Kong
- Division of NeurosurgeryDepartment of SurgeryFaculty of MedicineChinese University of Hong KongShatinHong Kong
| | - Kette D. Valente
- Department of PsychiatryFaculty of MedicineUniversity of Sao Paulo (HCFMUSP)Sao PauloBrazil
| | - Laura H. Goldstein
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Kirsten A. Donald
- Division of Developmental PaediatricsDepartment of Paediatrics and Child HealthRed Cross War Memorial Children’s Hospital and the Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Genevieve Rayner
- Melbourne School of Psychological SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Rosa Michaelis
- Department of NeurologyGemeinschaftskrankenhaus HerdeckeUniversity of Witten/HerdeckeHerdeckeGermany
- Department of NeurologyUniversity Hospital Knappschaftskrankenhaus BochumRuhr‐University BochumBochumGermany
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Suicidality in Epilepsy: Does It Share Common Pathogenic Mechanisms with Epilepsy? Curr Top Behav Neurosci 2021; 55:209-250. [PMID: 33683680 DOI: 10.1007/7854_2021_220] [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] [Indexed: 12/24/2022]
Abstract
Suicidality presents a major global health concern and its association with epilepsy has been suggested. The body of evidence is growing due to targeted epidemiological studies, genetic findings, and neuroimaging data, use of specific neuropsychiatric inventories, neuropsychological tests, and metabolic and immunological studies.Suicide tendencies and psychiatric comorbidity such as depression are not uncommon in chronic diseases, especially in epilepsy. Suicide is an important cause of death in epilepsy, and is usually underestimated. Persons with epilepsy have higher risk for suicide than healthy controls. It appears that some epilepsy types have stronger tendencies for suicide, in particular temporal lobe epilepsy. The suicidal risk factors in persons with epilepsy include difficult to treat epilepsies, onset of epilepsy at an earlier age, and comorbid depression.This clinical evidence is mostly based on observational studies in which we found an increased risk of suicidal ideation, suicidal attempts, and completed suicides in persons with epilepsy. However, we lack prospective and longitudinal studies on suicide in epilepsy. In this chapter we will examine recent research in neurobiological mechanisms between suicidality and epilepsy, and comorbid depression.
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Stefanidou M, Greenlaw C, Douglass LM. Mental Health Issues in Transition-Age Adolescents and Young Adults With Epilepsy. Semin Pediatr Neurol 2020; 36:100856. [PMID: 33308524 DOI: 10.1016/j.spen.2020.100856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mental health disorders are prevalent in patients with epilepsy, and adolescents are at particularly high risk. The reason for higher rates of anxiety, depression and suicide in young patients with epilepsy is likely multifactorial, and therefore the approach to treatment has proven challenging. In this review, we discuss important mental health topics for adolescents and young adults with epilepsy, as well as evidence for management. In the past several years, advances have been made in the transition of epilepsy care from pediatric to adult providers, creating a promising method for epilepsy patient engagement and empowerment. Future research into the mental health outcomes from these transition programs may lead to better strategies to support young patients with epilepsy.
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Affiliation(s)
- Maria Stefanidou
- Department of Neurology, Boston University School of Medicine, Boston, MA.
| | - Celia Greenlaw
- Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center, Boston, MA
| | - Laurie M Douglass
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center, Boston, MA
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25
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Kuroda N. Mental health considerations for patients with epilepsy during COVID-19 crisis. Epilepsy Behav 2020; 111:107198. [PMID: 32531704 PMCID: PMC7260596 DOI: 10.1016/j.yebeh.2020.107198] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Naoto Kuroda
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
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Mesraoua B, Deleu D, Hassan AH, Gayane M, Lubna A, Ali MA, Tomson T, Khalil BA, Cross JH, Asadi-Pooya AA. Dramatic outcomes in epilepsy: depression, suicide, injuries, and mortality. Curr Med Res Opin 2020; 36:1473-1480. [PMID: 32476500 DOI: 10.1080/03007995.2020.1776234] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this narrative review, we will discuss some of the significant risks and dramatic consequences that are associated with epilepsy: depression, suicide, seizure-related injuries, and mortality, both in adults and in children. Considering the high prevalence of depression among people with epilepsy (PWE), routine and periodic screening of all PWE for early detection and appropriate management of depression is recommended. PWE should be screened for suicidal ideation regularly and when needed, patients should be referred for a psychiatric evaluation and treatment. When starting an antiepileptic drug (AED) or switching from one to another AED, patients should be advised to report to their treating physician any change in their mood and existence of suicidal ideation. The risk of injuries for the general epilepsy population is increased only moderately. The risk is higher in selected populations attending epilepsy clinics and referral centers. This being said, there are PWE that may suffer frequent, severe, and sometimes even life-threatening seizure-related injuries. The most obvious way to reduce risk is to strive for improved seizure control. Finally, PWE have a 2-3 times higher mortality rate than the general population. Deaths in PWE may relate to the underlying cause of epilepsy, to seizures (including sudden unexpected death in epilepsy [SUDEP] and seizure related injuries) and to status epilepticus, as well as to other conditions that do not appear directly related to epilepsy. Improving seizure control and patient education may be the most important measures to reduce epilepsy related mortality in general and SUDEP in particular.
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Affiliation(s)
- Boulenouar Mesraoua
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Dirk Deleu
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Al Hail Hassan
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Melykian Gayane
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Alsheikh Lubna
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Torbjorn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Bassel Abou Khalil
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Helen Cross
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ali A Asadi-Pooya
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
- Epilepsy Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Vlasov PN, Karlov VA, Zhidkova IA, Dmitrenko DV, Rudakova IG, Danilova TV, Kalinin VA, Grebenyuk OV, Gertsen AP, Zhuravlev YS, Karas AY, Paramonova EN, Ponomareva IV, Miguskina OI, Sobyanina NA, Sukhova DV, Salomatin YV, Ertakhova ML, Goguadze TM, Shamray AP. A Russian retrospective multicenter open-label observational study based on medical documentation on the use of perampanel in everyday clinical practice. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2020. [DOI: 10.14412/2074-2711-2020-3-47-55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P. N. Vlasov
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | - V. A. Karlov
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | - I. A. Zhidkova
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | - D. V. Dmitrenko
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia
| | - I. G. Rudakova
- M.F. Vladimirsky Moscow Regional Clinical Research Institute
| | - T. V. Danilova
- Kazan State Medical University, Ministry of Health of Russia
| | - V. A. Kalinin
- Samara State Medical University, Ministry of Health of Russia
| | - O. V. Grebenyuk
- Siberian State Medical University, Ministry of Health of Russia
| | | | | | | | | | | | | | | | | | - Yu. V. Salomatin
- Z.P. Solovyev Research and Practical Psychoneurology Center, Moscow Healthcare Department
| | - M. L. Ertakhova
- Republican Children's Clinical Hospital, Ministry of Health of the Udmurt Republic
| | | | - A. P. Shamray
- Yu.K. Erdman Altai Territorial Clinical Mental Hospital
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Abstract
This article reviews common and clinically important neuropsychiatric aspects of epilepsy. Comorbidities are common, underdiagnosed, and powerfully impact clinical outcomes. Biological, psychological, and social factors contribute to the associations between epilepsy and neuropsychiatric disorders. Epidemiologic studies point to a bidirectional relationships between epilepsy and neuropsychiatric disorders. People with epilepsy are more likely to develop certain neuropsychiatric disorders, and those with these disorders are more likely to develop epilepsy. This relationship suggests the possibility of shared underlying pathophysiologies. We review the neuropsychiatric impact of antiseizure medications and therapeutic options for treatment. Diagnosis and treatment involve close collaboration among a multidisciplinary team.
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Affiliation(s)
- Benjamin Tolchin
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA; Epilepsy Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Lawrence J Hirsch
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA
| | - William Curt LaFrance
- Brown University, Rhode Island Hospital, Potter 3, 593 Eddy Street, Providence, RI 02903, USA
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Mula M, Kanner AM, Jetté N, Sander JW. Psychiatric Comorbidities in People With Epilepsy. Neurol Clin Pract 2020; 11:e112-e120. [PMID: 33842079 DOI: 10.1212/cpj.0000000000000874] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
Purpose of Review To review the latest evidence concerning the epidemiology, clinical implications, and management of psychiatric disorders in epilepsy. Recent Findings People with epilepsy have a 2-5 times increased risk of developing any psychiatric disorder, and 1 in 3 patients with epilepsy have a lifetime psychiatric diagnosis. Psychiatric comorbidities represent a poor prognostic marker as they have been associated with a poor response to treatment (drugs and surgery), increased morbidity, and mortality. Validated screening instruments are available for mood and anxiety disorders in adults as well as attention-deficit hyperactivity disorder in children with epilepsy. Summary All patients with epilepsy should be routinely screened for psychiatric disorder at the onset and at least once a year. Patients with epilepsy and their relatives should be informed of the risk of mental health problems and the implications.
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Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education (MM), St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology (AMK), Comprehensive Epilepsy Center and Epilepsy Division, University of Miami, Miller School of Medicine, FL; Division of Epilepsy and Division of Health Outcomes and Knowledge Translation Research (NJ), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York; NIHR UCL Hospitals Biomedical Research Centre (JWS), UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland-SEIN (JWS), Heemstede, the Netherlands
| | - Andres M Kanner
- Institute of Medical and Biomedical Education (MM), St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology (AMK), Comprehensive Epilepsy Center and Epilepsy Division, University of Miami, Miller School of Medicine, FL; Division of Epilepsy and Division of Health Outcomes and Knowledge Translation Research (NJ), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York; NIHR UCL Hospitals Biomedical Research Centre (JWS), UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland-SEIN (JWS), Heemstede, the Netherlands
| | - Nathalie Jetté
- Institute of Medical and Biomedical Education (MM), St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology (AMK), Comprehensive Epilepsy Center and Epilepsy Division, University of Miami, Miller School of Medicine, FL; Division of Epilepsy and Division of Health Outcomes and Knowledge Translation Research (NJ), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York; NIHR UCL Hospitals Biomedical Research Centre (JWS), UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland-SEIN (JWS), Heemstede, the Netherlands
| | - Josemir W Sander
- Institute of Medical and Biomedical Education (MM), St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology (AMK), Comprehensive Epilepsy Center and Epilepsy Division, University of Miami, Miller School of Medicine, FL; Division of Epilepsy and Division of Health Outcomes and Knowledge Translation Research (NJ), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York; NIHR UCL Hospitals Biomedical Research Centre (JWS), UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland-SEIN (JWS), Heemstede, the Netherlands
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Błaszczyk B, Walczak A, Ścirka N, Konarzewska A, Miziak B, Czuczwar SJ. Pharmacological and non-pharmacological approaches to life threatening conditions in epilepsy. JOURNAL OF EPILEPTOLOGY 2020. [DOI: 10.21307/jepil-2020-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Baandrup L. Polypharmacy in schizophrenia. Basic Clin Pharmacol Toxicol 2020; 126:183-192. [PMID: 31908124 DOI: 10.1111/bcpt.13384] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/26/2019] [Accepted: 12/27/2019] [Indexed: 12/16/2022]
Abstract
Schizophrenia is a severe mental disorder characterized by a heterogeneous symptom profile which comprises a clinical platform for widespread use of polypharmacy even though antipsychotic monotherapy is the recommended treatment regimen. This narrative review provides a summary of the current gap between evidence and practice for use of antipsychotic combination therapy in patients with schizophrenia. Antipsychotic polypharmacy is frequently prescribed instead of following international consensus of clozapine monotherapy in treatment-resistant patients. Antipsychotic-benzodiazepine combination therapy clearly has a role in the treatment of acute agitation whereas there is no evidence to support an effect on core schizophrenia symptoms when chronically prescribed. Antidepressants are typically added to antipsychotic treatment in case of persistent negative symptoms. Available evidence suggests that antidepressants may improve negative symptom control in schizophrenia. Combining an antipsychotic with an antiepileptic is not supported by any firm evidence, but individual mood stabilizers have come out positively in single trials. Generally, the evidence base for polypharmacy in schizophrenia maintenance treatment is sparse but may be warranted in certain clinical situations. Therapeutic benefits and side effects should be carefully monitored and considered to ensure a beneficial risk-benefit ratio if prescribing polypharmacy for specific clinical indications.
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Affiliation(s)
- Lone Baandrup
- Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Glostrup, Denmark.,Mental Health Centre Copenhagen, Hellerup, Denmark
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The psychopharmacology of epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2019. [PMID: 31727213 DOI: 10.1016/b978-0-444-64012-3.00012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Epilepsy affects 1% of the world's population and is defined as two or more unprovoked seizures. Psychiatric conditions (depression, psychosis, anxiety, and attention deficit hyperactivity disorder (ADHD)) may coexist and are linked to negative seizure outcomes and poorer quality of life. There is an increasing body of evidence to suggest a bidirectional relationship between epilepsy and psychiatric disorders, which may imply shared pathophysiologic mechanisms. Extensive research has examined neurobiologic and neuroanatomic substrates for this association revealing some interesting similarities. Psychiatric disorders in people with epilepsy often go underdiagnosed and undertreated, due to fears of exacerbating psychiatric symptoms or provoking seizures, which may cause delays in optimal management. This chapter covers psychiatric conditions in epilepsy largely focusing on depressive disorders and psychotic disorders. Anxiety and ADHD in association with epilepsy are also discussed. Epidemiology, pathophysiologic mechanisms, and pharmacotherapies used to treat epilepsy and psychiatric disorders are also covered.
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Dreier JW, Pedersen CB, Gasse C, Christensen J. Antiepileptic Drugs and Suicide: Role of Prior Suicidal Behavior and Parental Psychiatric Disorder. Ann Neurol 2019; 86:951-961. [DOI: 10.1002/ana.25623] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/06/2019] [Accepted: 10/13/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Julie W. Dreier
- National Center for Register‐Based ResearchAarhus University Aarhus Denmark
- Center for Integrated Register‐Based ResearchAarhus University Aarhus Denmark
| | - Carsten B. Pedersen
- National Center for Register‐Based ResearchAarhus University Aarhus Denmark
- Center for Integrated Register‐Based ResearchAarhus University Aarhus Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research Aarhus Denmark
| | - Christiane Gasse
- National Center for Register‐Based ResearchAarhus University Aarhus Denmark
- Department of Depression and Anxiety and Psychosis Research UnitAarhus University Hospital–Psychiatry Aarhus Denmark
| | - Jakob Christensen
- National Center for Register‐Based ResearchAarhus University Aarhus Denmark
- Department of NeurologyAarhus University Hospital Aarhus Denmark
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Costs and cost-drivers of a diagnosis of depression among adults with epilepsy in the United States. Epilepsy Behav 2019; 98:96-100. [PMID: 31301456 DOI: 10.1016/j.yebeh.2019.04.047] [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: 02/28/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the amount of direct costs associated with occurrence of depression in people with epilepsy. METHODS The Medical Expenditure Panel Survey Household Components (MEPS-HC) served as data source to identify adults (≥18 years) with epilepsy from 2003 to 2014, using the Clinical Classification Code CCC-83. Annual unadjusted per person total healthcare expenditures and individual cost components (inpatient, outpatient, prescription, emergency room, and home health) were compared between people with epilepsy and depression vs. without depression. A two-part model estimated the adjusted incremental direct cost of depression (total and individual cost components) among adults with epilepsy. The model was adjusted for sex, race/ethnicity, education, marital status, insurance status, census region, income, Charlson Comorbidities index (CCI), and year trend. RESULTS Out of a weighted 1,942,413 US adults with epilepsy, 675,037 (34.7%) had a diagnosis of depression. Annual total unadjusted per person direct cost of depression was $5290 higher in people with epilepsy vs. without [$18,776 (95% confidence interval [CI]: 16,241-21,311) vs. $13,486 (95%CI: 9780-17,191)]. Costs for outpatient and prescriptions were higher among people with epilepsy plus depression vs. without depression, but no differences were observed for inpatient, emergency room, and home health costs. In the adjusted model, total costs [$2523 (95%CI: 62-4984)], incremental annual direct costs per person for outpatient [$1940 (95%CI: 1266-2613)], prescriptions [$1285 (95%CI: 772-1798)], and emergency room [$191 (95%CI: 20-361)] were significantly higher for people with epilepsy plus depression. Unadjusted and adjusted incremental total aggregate annual direct costs of depression for people with epilepsy were $3.5 billion and $1.7 billion respectively. CONCLUSION Costs of epilepsy with presence of depression in the US are high, and primarily driven by outpatient, prescriptions, and emergency room costs.
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Knezevic NN, Aijaz T, Candido KD, Kovaleva S, Lissounov A, Knezevic I. The Effect of Once-Daily Gabapentin Extended Release Formulation in Patients With Postamputation Pain. Front Pharmacol 2019; 10:504. [PMID: 31156433 PMCID: PMC6529536 DOI: 10.3389/fphar.2019.00504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
Objectives To compare gabapentin extended-release, a gastro-retentive formulation, in relieving postamputation pain among gabapentin-experienced and gabapentin-naïve patients. Design Open-labeled pilot study. Subjects Sixteen patients with postamputation pain (8 patients in the gabapentin-experienced and 8 patients in the gabapentin-naïve groups). Methods Patients were started on gabapentin extended-release and were followed up for 8 weeks. Patients reported their pain severity during rest and movement using a numeric rating scale (NRS), interference of pain with daily activities using the modified brief pain inventory (MBPI) questionnaire, and treatment satisfaction using the treatment satisfaction questionnaire for medication (TSQM). Results Patients from both gabapentin-experienced and gabapentin-naïve groups achieved a significant and sustainable pain relief over the course of therapy. The pain scores at rest decreased in both gabapentin-experienced and gabapentin-naïve groups from 5.88 ± 1.36 and 4.88 ± 2.95 to 1.88 ± 0.99 and 1.38 ± 1.51, respectively. An average percent of pain relief with gabapentin extended-release was noted to be significant (p < 0.01) after 8 weeks of therapy among gabapentin-experienced (81.25 ± 16.42%) and gabapentin-naïve groups (85 ± 17.73%) when compared to baseline for gabapentin-experienced (31.25 ± 29%) and gabapentin-naïve groups (36.25 ± 34.2%), respectively. Gabapentin-experienced and gabapentin-naïve groups had no significant difference in global satisfaction from treatment (79.14 ± 10.47 and 83.3 ± 20.82), convenience of treatment (73.78 ± 19.04 and 90.44 ± 11.66), effectiveness of treatment (72.6 ± 10.1 and 79.73 ± 11.6). The only statistically significant difference among gabapentin-experienced and gabapentin-naïve groups was found in adverse event tolerability (65.78 ± 10.36 and 85.8 ± 10.14, p < 0.01). Conclusion Once-daily dosing of gabapentin-extended release showed significant improvement in pain severity and functional status, with no difference found between gabapentin-experienced versus gabapentin-naïve patients.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States.,Department of Anesthesiology, The University of Illinois at Chicago, Chicago, IL, United States.,Department of Surgery, The University of Illinois at Chicago, Chicago, IL, United States
| | - Tabish Aijaz
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States.,Department of Anesthesiology, The University of Illinois at Chicago, Chicago, IL, United States.,Department of Surgery, The University of Illinois at Chicago, Chicago, IL, United States
| | - Svetlana Kovaleva
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Alexei Lissounov
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Ivana Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
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Li Q, Zhu LN, Wang HJ, Lin X, Xu D, Chen D, Zhang Y, Liu L. Validation of the Neurological Disorders Depression Inventory for Epilepsy (NDDIE) as a rapid suicidality screening tool in Chinese people with epilepsy. Epilepsy Behav 2019; 94:216-221. [PMID: 30974350 DOI: 10.1016/j.yebeh.2019.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/17/2019] [Accepted: 03/17/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective of this study was to validate the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (NDDIE) as a suicidality screening tool in Chinese people with epilepsy (PWE). METHODS A consecutive cohort of PWE was recruited from West China Hospital and 363 Hospital. Each patient received a psychiatric evaluation with the Mini International Neuropsychiatric Interview (MINI) and the Chinese version of the NDDIE (C-NDDIE). Demographic and clinical characteristics were collected. Receiver operating characteristic (ROC) curve analysis was conducted. The best possible cutoff was identified with the highest Youden index. Specificity, sensitivity, positive, and negative predictive values were calculated. RESULTS Among a total of 355 participants, 41 (11.5%) had a moderate to high suicide risk according to the Suicidality Module (SM) of the MINI. Receiver operating characteristic (ROC) curve analysis showed that item 4 ("I'd be better off dead") of the NDDIE had an area under the curve (AUC) of 0.930 (95% confidence interval [CI] = 0.884-0.977), a sensitivity of 80.5%, a specificity of 94.9%, a positive predictive value (PPV) of 68.0%, a negative predictive value (NPV) of 97.7%, and the largest Youden index of 0.754 for a cutoff score of >2. CONCLUSION Item 4 of the NDDIE is a valuable tool for screening suicidality in Chinese PWE.
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Affiliation(s)
- Qian Li
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China; Department of Neurology, 363 Hospital, Daosangshu Road 108#, Chengdu, Sichuan 610041, China
| | - Li-Na Zhu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China
| | - Hai-Jiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China
| | - Xu Lin
- Department of Neurology, 363 Hospital, Daosangshu Road 108#, Chengdu, Sichuan 610041, China
| | - Da Xu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China
| | - Deng Chen
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China
| | - Yu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China.
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Vlasov PN. Use of valproate and carbamazepine in the therapy of epilepsy (guidelines for the practitioner). NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2018. [DOI: 10.14412/2074-2711-2018-4-129-138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The paper gives comparative data on the efficacy and tolerability of valproic acid (VA, valproate) and carbamazepine (CBZ) for different types of epilepsy and seizures in different age and clinical groups. The results of studies suggest that despite a more than 50-year history of their effective use, the extended-release formulations of VA and CBZ remain the drugs of first choice for many types of epilepsy.CBZ is effective for focal epilepsy and isolated generalized tonic-clonic seizures. However, its use is substantially limited by properties, such as cytochrome P450 induction and autoinduction, high drug-drug interactions, the aggravation of absences, negative myoclonus, myoclonic and atonic seizures, an effect on the profile of steroid sex hormones, elevated concentrations of atherogenic lipids and cholesterol, myocardial conduction disorders, and hyponatremia.Due to the multiple mechanism of action, VA is prescribed for almost all types of epilepsy and seizures in patients of different ages. VA should not be used (if the clinical situation allows) in women of childbearing age, in some infantile epileptic encephalopathy, inherited metabolic diseases, and chromosomal abnormalities. Effectiveness against different types of seizures and epilepsy, good tolerability, minimal aggravation risk, high retention rate of monotherapy, the presence of a variety of dosage forms, and favorable pharmacokinetic and pharmacodynamic profiles still make VA essential in many clinical situations.
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Affiliation(s)
- P. N. Vlasov
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
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Patel AD, Baca C, Franklin G, Herman ST, Hughes I, Meunier L, Moura LM, Munger Clary H, Parker-McFadden B, Pugh MJ, Schultz RJ, Spanaki MV, Bennett A, Josephson SA. Quality improvement in neurology. Neurology 2018; 91:829-836. [DOI: 10.1212/wnl.0000000000006425] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/25/2018] [Indexed: 11/15/2022] Open
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Friedman D, Spruill TM, Liu H, Tatsuoka C, Stoll S, Jobst BC, Fraser RT, Johnson EK, Chaytor N, Sajatovic M. Depressive symptoms and suicidality among individuals with epilepsy enrolled in self-management studies: Results from the US Centers for Disease Control and Prevention Managing Epilepsy Well (MEW) Network. Epilepsy Behav 2018; 87:235-240. [PMID: 30115600 DOI: 10.1016/j.yebeh.2018.06.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/30/2018] [Accepted: 06/15/2018] [Indexed: 11/20/2022]
Abstract
Depression is a common comorbidity in people with epilepsy (PWE) that negatively affects self-management and a variety of health outcomes. Suicidal ideation is also more common among PWE than the general population. We examined correlates of depressive symptoms and suicidal ideation in adults using pooled data from epilepsy self-management studies conducted by sites in the Centers for Disease Control and Prevention (CDC) Research Center's Managing Epilepsy Well (MEW) Network that assessed depression severity with the 9-item Patient Health Questionnaire (PHQ-9). Of the 770 subjects in the analysis (mean age 42.4 ± 13.0 years), the mean total PHQ-9 score was 9.4 ± 6.6 and 334 subjects (43.4%) had moderate to severe depressive symptoms (PHQ-9 ≥ 10). Only ongoing seizures and low education were associated with moderate-severe depressive symptoms in multiple logistic regression analysis. Suicidality (PHQ-9, item 9 score ≥ 1) was endorsed by 155 subjects (20.1%). Only nonsuicidal depressive symptoms were associated with suicidality in multiple variable logistic regression analysis. We show in this large and regionally diverse dataset that both depression and suicidal ideation are common among PWE enrolled in self-management studies. Future studies are needed to examine whether suicidality exists independently of other depressive symptoms in some populations with epilepsy and investigate other correlates of suicidality that may inform screening practices.
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Affiliation(s)
- Daniel Friedman
- Department of Neurology, NYU School of Medicine, New York, NY, United States.
| | - Tanya M Spruill
- Department of Population Health, NYU School of Medicine, New York, NY, United States
| | - Hongyan Liu
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Shelley Stoll
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, United States
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Robert T Fraser
- School of Public Health, Univ. of Washington, Seattle, WA, United States
| | - Erica K Johnson
- School of Public Health, Univ. of Washington, Seattle, WA, United States
| | - Naomi Chaytor
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Martha Sajatovic
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Departments of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
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Abstract
PURPOSE OF REVIEW To review some aspects of the relationship between epilepsy and depression that have recently received increasing attention and may become major research topics in the near future. RECENT FINDINGS Epidemiological studies show that depression and suicide are, in some cases, premorbid symptoms preceding the onset of the epilepsy. Suicide is also three times more frequent in epilepsy than in the general population. Reliable screening instruments for depression and suicidality in patients with epilepsy are now available but data from real life clinical settings are needed to develop shared clinical pathways between neurology and psychiatry. Data in children with epilepsy are still limited although it is well known that, outside epilepsy, almost 50% of adult patients with mood and anxiety disorders have a previous history during childhood. Despite increasing attention to the problem, the additional stigma associated with mental health problems still represents one of the major barriers to prompt diagnosis and treatment. SUMMARY New studies will focus on the development of shared clinical pathways between neurology and psychiatry for mood disorders and suicide prevention. New global campaigns on the double stigma will support this process in areas where psychiatric comorbidities are still underdiagnosed and undertreated.
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Andermann E, Biton V, Benbadis SR, Shneker B, Shah AK, Carreño M, Trinka E, Ben-Menachem E, Biraben A, Rocha F, Gama H, Cheng H, Blum D. Psychiatric and cognitive adverse events: A pooled analysis of three phase III trials of adjunctive eslicarbazepine acetate for partial-onset seizures. Epilepsy Behav 2018; 82:119-127. [PMID: 29604484 DOI: 10.1016/j.yebeh.2017.12.017] [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: 04/26/2017] [Revised: 11/20/2017] [Accepted: 12/18/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the nature and incidence of psychiatric and cognitive adverse events (AEs) reported with eslicarbazepine acetate (ESL) used as adjunctive treatment for refractory partial-onset seizures (POS) in adults. METHODS This was a post-hoc analysis of data pooled from three randomized double-blind, placebo-controlled trials (BIA-2093-301, -302, -304). After an 8-week baseline period, patients received placebo or adjunctive ESL 400mg (studies 301 and 302 only), 800mg, or 1200mg once daily (QD) for 14weeks (2-week titration period, 12-week maintenance period). Psychiatric and cognitive AEs were identified from individual patient data. Suicidality was also evaluated using the Columbia-Classification Algorithm of Suicide Assessment (C-CASA), or the Columbia-Suicide Severity Rating Scale (C-SSRS). P-values were obtained using the chi-square test of independence or Fisher's exact test, without correcting for multiplicity. RESULTS The analysis population included 1447 patients (ESL, n=1021; placebo, n = 426). Psychiatric treatment-emergent AEs (TEAEs) occurred in 10.8% of patients receiving ESL, and in a comparable proportion (10.3%) of patients receiving placebo (p=0.802). The incidence of depression and suicidality-related TEAEs was higher for ESL (7.4%) vs. placebo (3.8%) (p=0.009). The occurrence of these TEAEs differed between treatment groups (p = 0.010), but there was no notable trend between increasing ESL dose and increasing incidence of depression and suicidality-related TEAEs. Aggression/hostility-related TEAEs occurred in <0.1% of patients taking ESL vs. 0.9% taking placebo. The incidence of cognitive TEAEs was higher for ESL (7.1%) vs. placebo (4.0%) (p=0.023); incidences of memory impairment, attention disturbance, apathy, and aphasia were higher for ESL 1200mg than for other treatment groups. Incidences of psychiatric and cognitive serious AEs (SAEs) were 0.6% and 0.2% with ESL, and 0.5% and 0% with placebo, respectively. Psychiatric and cognitive TEAEs leading to discontinuation occurred in 1.9% and 1.4% of patients taking ESL, and 0.7% and 0.5% taking placebo, respectively. CONCLUSIONS In phase III clinical trials of adjunctive ESL for treatment-refractory POS, psychiatric and cognitive TEAEs were reported infrequently with ESL and placebo. The incidences of depression and suicidality-related TEAEs and of cognitive TEAEs were higher for patients taking ESL vs. placebo. Incidences of psychiatric and cognitive SAEs, and TEAEs leading to discontinuation, were low with ESL and placebo.
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Affiliation(s)
- Eva Andermann
- Neurogenetics Unit and Epilepsy Research Group, Montreal Neurological Institute and Hospital, 3801 University Street, Suite 127, Montreal, QC H3A 2B4, Canada; Department of Neurology and Neurosurgery, Department of Human Genetics, McGill University, Montreal, QC, Canada.
| | - Victor Biton
- Arkansas Epilepsy Program, Clinical Trials Inc., 2 Lile Court, Suite 100, Little Rock, AR 72205, USA.
| | - Selim R Benbadis
- Department of Neurology, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL 33606, USA
| | - Bassel Shneker
- Nuvasive Inc., 7475 Lusk Blvd., San Diego, CA 92121, USA; OhioHealth, 1010 Refugee Rd, Pickerington, OH 43147, USA; Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, USA(2)
| | - Aashit K Shah
- Wayne State University, 4201 St Antoine, Detroit, MI 48201, USA; Detroit Medical Center, 4201 St. Antoine, Detroit, MI 48201, USA
| | - Mar Carreño
- Epilepsy Unit, Hospital Clinic, Villarroel 170, Barcelona 08036, Spain
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Ignaz Harrestrasse 79, Salzburg 5020, Austria; Department of Public Health and Health Technology Assessment, UMIT - University of Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria
| | - Elinor Ben-Menachem
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg 41345, Sweden
| | - Arnaud Biraben
- CHU Pontchaillou, 2 Rue Henri le Guilloux, Rennes 35000, France
| | - Francisco Rocha
- BIAL - Portela & C(a), S.A., Avenida da Siderurgia Nacional, 4745-457 São Mamede do Coronado, Portugal
| | - Helena Gama
- BIAL - Portela & C(a), S.A., Avenida da Siderurgia Nacional, 4745-457 São Mamede do Coronado, Portugal
| | - Hailong Cheng
- Sunovion Pharmaceuticals Inc., 84 Waterford Dr, Marlborough, MA 01752, USA
| | - David Blum
- Sunovion Pharmaceuticals Inc., 84 Waterford Dr, Marlborough, MA 01752, USA
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Mula M. Do anti-epileptic drugs increase suicide in epilepsy? 10 years after the FDA alert. Expert Rev Neurother 2018; 18:177-178. [DOI: 10.1080/14737175.2018.1427067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education, St George’s University of London and Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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Bonnet U, Scherbaum N. How addictive are gabapentin and pregabalin? A systematic review. Eur Neuropsychopharmacol 2017; 27:1185-1215. [PMID: 28988943 DOI: 10.1016/j.euroneuro.2017.08.430] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/16/2017] [Accepted: 08/20/2017] [Indexed: 12/21/2022]
Abstract
In the last ten years, gabapentin and pregabalin have been becoming dispensed broadly and sold on black markets, thereby, exposing millions to potential side-effects. Meanwhile, several pharmacovigilance-databases have warned for potential abuse liabilities and overdose fatalities in association with both gabapentinoids. To evaluate their addiction risk in more detail, we conducted a systematic review on PubMed/Scopus and included 106 studies. We did not find convincing evidence of a vigorous addictive power of gabapentinoids which is primarily suggested from their limited rewarding properties, marginal notes on relapses, and the very few cases with gabapentinoid-related behavioral dependence symptoms (ICD-10) in patients without a prior abuse history (N=4). In support, there was no publication about people who sought treatment for the use of gabapentinoids. Pregabalin appeared to be somewhat more addictive than gabapentin regarding the magnitude of behavioral dependence symptoms, transitions from prescription to self-administration, and the durability of the self-administrations. The principal population at risk for addiction of gabapentinoids consists of patients with other current or past substance use disorders (SUD), mostly opioid and multi-drug users, who preferred pregabalin. Pure overdoses of gabapentinoids appeared to be relative safe but can become lethal (pregabalin > gabapentin) in mixture with other psychoactive drugs, especially opioids again and sedatives. Based upon these results, we compared the addiction risks of gabapentin and pregabalin with those of traditional psychoactive substances and recommend that in patients with a history of SUD, gabapentinoids should be avoided or if indispensable, administered with caution by using a strict therapeutic and prescription monitoring.
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Affiliation(s)
- U Bonnet
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Grutholzallee 21, D-44577 Castrop-Rauxel, Germany; LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, D-45147 Essen, Germany.
| | - N Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, D-45147 Essen, Germany
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Heyman E, Lahat E, Levin N, Epstein O, Lazinger M, Berkovitch M, Gandelman-Marton R. Tolerability and efficacy of perampanel in children with refractory epilepsy. Dev Med Child Neurol 2017; 59:441-444. [PMID: 27935018 DOI: 10.1111/dmcn.13362] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 12/19/2022]
Abstract
AIM There are few reports on the tolerability and efficacy of perampanel, a new antiepileptic drug with a novel mechanism of action, in children and adolescents. We aimed to describe our experience with perampanel add-on and mono-therapy in children with refractory epilepsy. METHOD Computerized medical records of children treated with perampanel in the paediatric neurology clinic from December 2012 to October 2015 were reviewed. RESULTS Twenty-four children treated with perampanel (15 females, 9 males) aged 1 year 6 months to 17 years (mean 10y, standard deviation [SD] 4y 5mo) were identified. Adverse events were more common in children aged 12 years or older (89%) compared to younger children (53%), and were mainly behavioural. Ten (42%) children had 50 per cent or higher seizure reduction, two (8%) children had 33 per cent seizure reduction, and seizures were less severe in one (4%) child. Perampanel was discontinued in 13 (54%) children mostly due to adverse events. The mean duration of follow-up in the remaining 11 children was 8.1 months (SD 5.2) (range 1.3-17mo). INTERPRETATION Perampanel is associated with a relatively high rate of behavioural adverse events mostly in adolescents with refractory epilepsy.
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Affiliation(s)
- Eli Heyman
- Department of Pediatric Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Lahat
- Department of Pediatric Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Levin
- Department of Pediatric Neurology, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Orna Epstein
- Department of Pediatric Neurology, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Mirit Lazinger
- Department of Pediatric Neurology, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Matitiahu Berkovitch
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Clinical Pharmacology Unit, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Revital Gandelman-Marton
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Electroencephalography Laboratory, Assaf Harofeh Medical Center, Zerifin, Israel
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Abstract
INTRODUCTION Myoclonic seizures are brief, involuntary muscular jerks arising from the central nervous system that can occur in different epilepsy syndromes, including idiopathic generalized epilepsies or the most severe group of epileptic encephalopathies. Valproate is commonly the first choice alone or in combination with some benzodiazepines or levetiracetam. However, more treatment options exist today as there is emerging evidence to support the efficacy of some newer antiepileptic drugs. In addition, of major importance remains avoidance of medications (e.g., carbamazepine, phenytoin) that may aggravate myoclonic seizures. This is an updated review on the available therapeutic options for treatment of myoclonic seizures. Areas covered: Key efficacy, tolerability and efficacy data are showed for different antiepileptic drugs with antimyoclonic effect, alone and/or in combination. Expert opinion: Pharmacological treatment of myoclonic seizures is based on clinical experience with little evidence from randomized clinical trials. Valproate, levetiracetam, and some benzodiazepines, are widely used. There is still insufficient evidence for the use of other antiseizure drugs, such as topiramate or zonisamide as monotherapy. Better understanding of pathophysiologic mechanisms of myoclonic epilepsies could yield great improvement in the treatment and quality of life of patients.
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Affiliation(s)
- Pasquale Striano
- a Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health , University of Genoa, 'G. Gaslini' Institute , Genova , Italy
| | - Vincenzo Belcastro
- b Neurology Unit, Department of Medicine , Sant'Anna Hospital , Como , Italy
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Grimaldi-Bensouda L, Nordon C, Rossignol M, Jardon V, Boss V, Warembourg F, Reynolds R, Kurz X, Rouillon F, Abenhaim L. Antiepileptic drugs and risk of suicide attempts: a case-control study exploring the impact of underlying medical conditions. Pharmacoepidemiol Drug Saf 2017; 26:239-247. [DOI: 10.1002/pds.4160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 10/05/2016] [Accepted: 12/05/2016] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Michel Rossignol
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal Canada
| | - Vincent Jardon
- Service de Psychiatrie; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - Virginie Boss
- Service de Psychiatrie; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - Frédérique Warembourg
- Service de Psychiatrie; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | | | - Xavier Kurz
- Inspections & Human Medicines, Monitoring & Incident Management; European Medicines Agency; London UK
| | - Frédéric Rouillon
- Clinique des Maladies Mentales et de l'Encéphale, Centre Hospitalier Sainte Anne; Université Paris V René Descartes; Paris France
| | - Lucien Abenhaim
- LASER Research; Paris France
- Department of Epidemiology; London School of Hygiene & Tropical Medicine; London UK
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Roynard P, Castel C, Lebain P, Roupie É, Saint-Lorant G. [Not Available]. REVUE DE L'INFIRMIERE 2017; 66:45-46. [PMID: 28048997 DOI: 10.1016/j.revinf.2016.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Pauline Roynard
- Pharmacie centrale, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
| | - Camille Castel
- Pharmacie centrale, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
| | - Pierrick Lebain
- Service de psychiatrie adulte, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
| | - Éric Roupie
- Département d'accueil et de traitement des urgences, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
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Zelano J, Ben-Menachem E. Treating epileptic emergencies - pharmacological advances. Expert Opin Pharmacother 2016; 17:2227-2234. [PMID: 27686410 DOI: 10.1080/14656566.2016.1241236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Epileptic emergencies are frequently encountered and include ictal events as status epilepticus or seizure clusters, and non-ictal situations like postictal psychosis or acute drug side effects. The aim of this review was to describe recent pharmacological advances in the treatment of epileptic emergencies. Areas covered: Based on clinically relevant questions, a literature search was performed. The search showed that most pharmacological advances have been made in management of status epilepticus, where substantial literature has accumulated on several AEDs with potentially less side-effects than the traditional choices. The use of these drugs; valproate, levetiracetam, and lacosamide, was therefore made the main focus of this review. Pharmacological advances in treatment of other epileptic emergencies were scarce, and were therefore covered more briefly in the Expert Opinion section. Expert opinion: This section outlines our current practice in management of status epilepticus and seizures clusters. Our opinion is that valproate is an equal alternative as second line treatment to fosphenytoin, with levetiracetam considered a good choice in frail and elderly patients. Due to the lack of literature, lacosamide is used mainly as a 2nd line drug after the failure of valproate, fosphenytoin and levetiracetam. Our review underlines the need for more research in management of epileptic emergencies.
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Affiliation(s)
- Johan Zelano
- a Department of Clinical Neuroscience and Department of Neurology, Sahlgrenska Academy , University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Elinor Ben-Menachem
- a Department of Clinical Neuroscience and Department of Neurology, Sahlgrenska Academy , University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
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Abstract
Suicidal behavior is strongly associated with depression, especially if accompanied by behavioral activation, dysphoria, or agitation. It may respond to some treatments, but the design of scientifically sound, ethical trials to test for therapeutic effects on suicidal behavior is highly challenging. In bipolar disorder, and possibly also unipolar major depression, an underprescribed medical intervention with substantial evidence of preventive effects on suicidal behavior is long-term treatment with lithium. It is unclear whether this effect is specifically antisuicidal or reflects beneficial effects of lithium on depression, mood instability, and perhaps aggression and impulsivity. Antisuicidal effects of anticonvulsant mood stabilizers (carbamazepine, lamotrigine, valproate) appear to be less than with lithium. Further evaluation is needed for potential antisuicidal effects of atypical antipsychotics with growing evidence of efficacy in depression, particularly acute bipolar depression, while generally lacking risk of inducing agitation, mania, or mood instability. Short-term and long-term value and safety of antidepressants are relatively secure for unipolar depression but uncertain and poorly tested for bipolar depression; their effects on suicidal risk in unipolar depression may be age-dependent. Sedative anxiolytics are virtually unstudied as regards suicidal risks. Adequate management of suicidal risks in mood disorder patients requires comprehensive, clinically skillful monitoring and timely interventions.
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