Effectiveness of antipsychotic drug therapy for treating psychosis in people with epilepsy: A systematic review.

IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY
Epilepsia Pub Date : 2024-10-21 DOI:10.1111/epi.18123
Aryan Arora, Priya Prakash, Laura Rizzo, Graham Blackman, Anthony S David, Jonathan P Rogers
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引用次数: 0

Abstract

Individuals with epilepsy are at risk of developing preictal, ictal, postictal and interictal psychoses. Antipsychotic drugs (APDs) are the main class of drugs used to treat psychosis and schizophrenia. The efficacy and safety of APDs as a treatment for epileptic psychosis is not well understood. This systematic review aimed to assess the effectiveness and adverse effects of APDs for treating psychosis in people with epilepsy. We adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched MEDLINE, Embase, PsycInfo, and AMED (Allied and Complementary Medicine) from database inception to June 20, 2023. We contacted experts in the field and performed citation searches to identify additional records. Title, abstract, full-text review, and data analysis were conducted in duplicate, with conflicts resolved by discussion among authors. Given the considerable heterogeneity of study designs, meta-analysis was not deemed appropriate; instead, the results were tabulated in a narrative synthesis. The Joanna Briggs Institute Risk of Bias tool and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework were used to assess study quality. We identified 13 studies with a total of 1180 participants. In the four case series included, the psychotic symptoms of 25 of 28 patients treated with APDs partially improved or fully resolved. Three of the four cohort studies reported an association between antipsychotic use and longer duration of psychotic episodes, two found similar results in both APD and non-APD groups, and two did not report control psychosis outcomes. When reported, seizure frequency was observed to remain unchanged or decrease following APD treatment. The evidence on the effectiveness of antipsychotics in the treatment of psychosis in epilepsy is inconclusive and may reflect confounding by indication. However, most studies suggest that antipsychotics were not associated with a marked worsening in seizure frequency. It remains unclear whether antipsychotics should be used in epilepsy, and well-controlled cohort studies and randomized controlled trials are necessary to draw definitive conclusions.

抗精神病药物治疗癫痫患者精神病的有效性:系统综述。
癫痫患者有罹患发作前、发作时、发作后和发作间歇期精神病的风险。抗精神病药物(APDs)是用于治疗精神病和精神分裂症的主要药物类别。抗精神病药物治疗癫痫性精神病的疗效和安全性尚不十分清楚。本系统性综述旨在评估 APDs 治疗癫痫患者精神病的有效性和不良反应。我们遵循了 PRISMA(系统综述和元分析首选报告项目)指南。我们检索了 MEDLINE、Embase、PsycInfo 和 AMED(联合与补充医学),检索时间从数据库建立之初至 2023 年 6 月 20 日。我们联系了该领域的专家并进行了引文检索,以确定更多记录。标题、摘要、全文审阅和数据分析一式两份,作者之间的冲突通过讨论解决。鉴于研究设计存在很大的异质性,我们认为进行荟萃分析并不合适;相反,我们将结果以表格的形式进行了叙述性综合。乔安娜-布里格斯研究所(Joanna Briggs Institute)的偏倚风险工具和 GRADE(建议评估、发展和评价分级)框架用于评估研究质量。我们确定了 13 项研究,共有 1180 名参与者。在纳入的四项病例系列研究中,接受 APDs 治疗的 28 名患者中有 25 人的精神病症状得到部分改善或完全缓解。四项队列研究中有三项报告了抗精神病药物的使用与精神病发作持续时间延长之间的关系,两项研究发现 APD 组和非 APD 组的结果相似,还有两项研究没有报告控制精神病的结果。据观察,在接受 APD 治疗后,发作频率保持不变或有所下降。关于抗精神病药物治疗癫痫性精神病疗效的证据尚无定论,可能与适应症有关。不过,大多数研究表明,抗精神病药物与癫痫发作频率的明显恶化无关。抗精神病药物是否应在癫痫患者中使用,目前仍不清楚,要得出明确的结论,还需要有良好控制的队列研究和随机对照试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Epilepsia
Epilepsia 医学-临床神经学
CiteScore
10.90
自引率
10.70%
发文量
319
审稿时长
2-4 weeks
期刊介绍: Epilepsia is the leading, authoritative source for innovative clinical and basic science research for all aspects of epilepsy and seizures. In addition, Epilepsia publishes critical reviews, opinion pieces, and guidelines that foster understanding and aim to improve the diagnosis and treatment of people with seizures and epilepsy.
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