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Epilepsy, Antiepileptic Drugs, and Aggression: An Evidence-Based Review.

Brodie, MJ; Besag, F; Ettinger, AB; Mula, M; Gobbi, G; Comai, S; Aldenkamp, AP; Steinhoff, BJ (2016) Epilepsy, Antiepileptic Drugs, and Aggression: An Evidence-Based Review. Pharmacol Rev, 68 (3). pp. 563-602. ISSN 1521-0081 https://doi.org/10.1124/pr.115.012021
SGUL Authors: Mula, Marco

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Abstract

Antiepileptic drugs (AEDs) have many benefits but also many side effects, including aggression, agitation, and irritability, in some patients with epilepsy. This article offers a comprehensive summary of current understanding of aggressive behaviors in patients with epilepsy, including an evidence-based review of aggression during AED treatment. Aggression is seen in a minority of people with epilepsy. It is rarely seizure related but is interictal, sometimes occurring as part of complex psychiatric and behavioral comorbidities, and it is sometimes associated with AED treatment. We review the common neurotransmitter systems and brain regions implicated in both epilepsy and aggression, including the GABA, glutamate, serotonin, dopamine, and noradrenaline systems and the hippocampus, amygdala, prefrontal cortex, anterior cingulate cortex, and temporal lobes. Few controlled clinical studies have used behavioral measures to specifically examine aggression with AEDs, and most evidence comes from adverse event reporting from clinical and observational studies. A systematic approach was used to identify relevant publications, and we present a comprehensive, evidence-based summary of available data surrounding aggression-related behaviors with each of the currently available AEDs in both adults and in children/adolescents with epilepsy. A psychiatric history and history of a propensity toward aggression/anger should routinely be sought from patients, family members, and carers; its presence does not preclude the use of any specific AEDs, but those most likely to be implicated in these behaviors should be used with caution in such cases.

Item Type: Article
Additional Information: Copyright © 2016 The Author(s) This is an open access article distributed under the CC-BY Attribution 4.0 International license (http://creativecommons.org/licenses/by/4.0/).
Keywords: Pharmacology & Pharmacy, 1115 Pharmacology And Pharmaceutical 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: Pharmacol Rev
ISSN: 1521-0081
Language: eng
Dates:
DateEvent
1 July 2016Published
12 May 2016Published Online
24 February 2016Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 27255267
Web of Science ID: WOS:000376132300002
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/108099
Publisher's version: https://doi.org/10.1124/pr.115.012021

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