Increased frequency of psychosis after second-generation antiepileptic drug administration in adults with focal epilepsy.

Abstract

OBJECTIVE:

Many studies show psychoses after some antiepileptic drug (AED) administrations (post-AED administration psychoses [PAP]). It remains uncertain about psychogenetic potential of each AED and effects of clinical state factors on PAP. We examined the relations between AED-related factors (types, generations, dosages, and concomitant AED) and PAP.

METHODS:

The clinical records of patients with focal epilepsy were retrospectively reviewed from eight adult epilepsy clinics, for every six-month period after administration of a new drug (either AED or non-AED) between 1981 and 2015. Characteristics of psychotic episodes, AED-related factors (type, daily dosage, and concomitant AED), and other state-related risk factors to psychosis (age, duration of epilepsy, history of psychosis, and seizure frequency) were examined. Psychogenetic risks of AED-related and state-related factors were analyzed with multifactorial procedures.

RESULTS:

Of 2067 patients with focal epilepsy, 5018 new drugs (4402 AEDs and 616 non-AEDs) were administered. Within the first six-month period, 89 patients exhibited 105 psychotic episodes (81 interictal and 24 postictal psychoses: 55 first episodes and 50 recurrences). With second-generation AED (SAED) administration, particularly topiramate and lamotrigine, frequency of psychosis was significantly increased. Daily dosage of AED was not significantly associated with psychosis. Psychosis tended to occur with a higher number of concomitant AED. Subsequent analysis with AED-related and general factors showed that SAED administrations and previous psychotic history were the most significant risks for PAP.

CONCLUSION:

Post-AED administration psychoses is associated with type of AED (SAED), rather than its dosage. Individual vulnerabilities are also associated with PAP.

• Authors: Naoto Adachi, Peter Fenwick, Nozomi Akanuma, Koichiro Hara, Ryouhei Ishii, Mitsutoshi Okazaki, Masumi Ito, Masanori Sekimoto, Masaaki Kato, Teiichi Onuma
• Journal: Epilepsy & behavior : E&B (Epilepsy Behav) Vol. 97 Pg. 138-143 (08 2019) ISSN: 1525-5069 [Electronic] United States
• PMID: 31252268 (Publication Type: Journal Article)
• Copyright: Copyright © 2019. Published by Elsevier Inc.

Chemical References

• Anticonvulsants
• Topiramate
• Lamotrigine

Topics

• Adult
• Aged
• Aged, 80 and over
• Anticonvulsants (adverse effects, therapeutic use)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Epilepsies, Partial (complications, drug therapy)
• Female
• Follow-Up Studies
• Humans
• Lamotrigine (adverse effects, therapeutic use)
• Male
• Middle Aged
• Psychoses, Substance-Induced (epidemiology, etiology)
• Retrospective Studies
• Risk Factors
• Topiramate (adverse effects, therapeutic use)