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Interventions for psychotic symptoms concomitant with epilepsyFarooq S, Sherin A
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SummaryInterventions for psychotic symptoms concomitant with epilepsyLittle evidence to inform the treatment of psychosis in people with epilepsy. There is substantial evidence that people suffering from epilepsy have an increased risk of suffering from psychotic symptoms. These symptoms sometimes occur soon after or before the epileptic fits but in some cases can persist for a much longer time, even in the absence of seizures. The management of those suffering from psychosis related to epilepsy is complicated by the fact that most of the drugs used for controlling the symptoms of psychotic disorders can interfere with the effective control of epilepsy and vice versa. Only one small trial met the inclusion criteria for this review. At present there is a lack of evidence to inform the treatment of psychosis in people with epilepsy and further randomized controlled trials are needed.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 08. 2008 AbstractBackgroundPeople suffering from epilepsy have an increased risk of suffering from psychotic symptoms. The psychotic syndromes associated with epilepsy have generally been classified as ictal, postictal and interictal psychosis. Anticonvulsant drugs have been reported to precipitate psychosis. Moreover, all antipsychotic drugs have the propensity to cause paroxysmal EEG abnormalities and induce seizures. ObjectivesTo evaluate the benefits of interventions used to treat clinically significant psychotic symptoms occurring in people with epilepsy with regard to global improvement, changes in mental state, hospitalization, behavior, quality of life, effect on the frequency of seizures and interaction with antiepileptic drugs. Search strategyWe searched the Trials Registers of the Cochrane Schizophrenia Group and the Cochrane Epilepsy Group (May 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2008), MEDLINE (Ovid, 1950 to14 May 2008), EMBASE (1980 to 2006), PsycINFO (1872 to 12 May 2008), CINAHL (1981 to 9 May 2008) and Biological Abstracts using the Cochrane Schizophrenia Group's phrase for randomized controlled trials and schizophrenia or psychotic disorders combined with the phrase [and {epilepsy* or seizure disorders* }]. Two review authors (SF and AS) independently inspected the citations identified from the search. We identified potentially relevant abstracts and assessed full papers for inclusion and methodological quality. Selection criteriaAll randomized controlled trials comparing drugs, behavior therapy, cognitive behavior therapy or other non-pharmacological interventions used to relieve psychotic symptoms in people with epilepsy. Data collection and analysisWe planned to extract and analyze the data from all relevant studies using standardized methods. As only one study met the inclusion criteria, no meta-analysis was attempted. Main resultsAfter independently assessing the abstracts and titles of 492 articles, we selected five relevant abstracts. Ultimately we found only one study meeting the inclusion criteria, which was available only as an abstract. This study compared the use of olanzapine (10 mg/day) with haloperidol (12 mg/day) in 16 patients suffering from schizophrenia-like psychosis of epilepsy (SLPE). Thirteen patients completed the study. Significant improvement was associated with use of olanzapine. We did not identify any study on psychosocial interventions in patients suffering from epilepsy and psychosis. Authors' conclusionsOnly one randomized controlled trial was found which lacked the power to test the efficacy of antipsychotics in those suffering from psychosis concomitant with epilepsy. Limited evidence from this small RCT suggests an improvement in psychotic symptoms, but not other outcome measures, with the use of an antipsychotic. The effects on seizure control are not well studied. Further trials are required to inform practice. |