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Pharmacotherapy in patients with epilepsy and psychosis.

de Toffol, B; Trimble, M; Hesdorffer, DC; Taylor, L; Sachdev, P; Clancy, M; Adachi, N; Bragatti, JA; Mula, M; Kanemoto, K (2018) Pharmacotherapy in patients with epilepsy and psychosis. Epilepsy Behav, 88. pp. 54-60. ISSN 1525-5069 https://doi.org/10.1016/j.yebeh.2018.09.001
SGUL Authors: Mula, Marco

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Abstract

The recognition and treatment of psychosis in persons with epilepsy (PWE) is recommended with the apparent dilemma between treating psychosis and opening the possibility of exacerbating seizures. The pooled prevalence estimate of psychosis in PWE is 5.6%. It has been proposed that a 'two hit' model, requiring both aberrant limbic activity and impaired frontal control, may account for the wide range of clinical phenotypes. The role of antiepileptic drugs in psychosis in PWE remains unclear. Alternating psychosis, the clinical phenomenon of a reciprocal relationship between psychosis and seizures, is unlikely to be an exclusively antiepileptic drug-specific phenomenon but rather, linked to the neurobiological mechanisms underlying seizure control. Reevaluation of antiepileptic treatment, including the agent/s being used and degree of epileptic seizure control is recommended. The authors found very few controlled studies to inform evidence-based treatment of psychosis in PWE. However, antipsychotics and benzodiazepines are recommended as the symptomatic clinical treatments of choice for postictal and brief interictal psychoses. The general principle of early symptomatic treatment of psychotic symptoms applies in epilepsy-related psychoses, as for primary psychotic disorders. In the authors' experience, low doses of antipsychotic medications do not significantly increase clinical risk of seizures in PWE being concurrently treated with an efficacious antiepileptic regimen.

Item Type: Article
Additional Information: © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Alternating psychosis, Anticonvulsants, Antiepileptics, Antipsychotics, Epilepsy, Interictal psychosis, Postictal psychosis, Psychosis, Seizures, Neurology & Neurosurgery, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Journal or Publication Title: Epilepsy Behav
ISSN: 1525-5069
Language: eng
Dates:
DateEvent
November 2018Published
18 September 2018Published Online
1 September 2018Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
PubMed ID: 30241054
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110180
Publisher's version: https://doi.org/10.1016/j.yebeh.2018.09.001

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