Psychotic Symptoms with Long-Term Lamotrigine Therapy for Temporal Lobe Epilepsy.
Abstract number :
J.06
Submission category :
Year :
2001
Submission ID :
264
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
R.W. Gabr, MD, PhD, Medicine (Neurology), Duke University, Durham, NC; P. Miller, RN, Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, NC; S.T. Carwile, RN, BSN, Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, NC; M. Volow
RATIONALE: Behavioral side effects of antiepileptic drugs (AEDs) in the treatment of temporal lobe epilepsy (TLE) have long been recognized. Emergence of psychosis with initiation of many of the newer generation AEDs has been documented, including vigabatrin, zonisamide, tiagabine and topiramate. Risk factors for development of psychosis have been postulated, including concomitant carbamazepine (CBZ) use, previous history of psychosis, sudden cessation of seizures and polypharmacy. We report a series of 6 patients with TLE who developed psychosis months to years after intiation of therapy with lamotrigine (LTG).
METHODS: The patients described in this report were followed 3-18 years prior to LTG therapy at the Durham Veterans Affairs Medical Center (DVAMC) Neurodiagnostic Clinic. Behavioral symptoms after initiation of LTG were identified either during routine nursing or physician interviews (4 patients) or during acute hospitalization for treatment of psychosis (2 patients).
RESULTS: Psychotic symptoms included paranoia, hypervigilance, hyperreligiosity, and violent behavior. Time to onset of psychotic symptoms ranged from 3 months to 2 years. Symptoms occurred with LTG levels ranging from 4.7 to 23. One patient had similar symptoms previously while taking vigabatrin; none of the other patients had a prior history of psychosis. Two patients had a pre-morbid history of affective disorder. Concomitant AEDs included topiramate (2), phenytoin (1), levetiracetam (1) and CBZ (1). Two patients were on monotherapy due to side effects. Duration of psychosis prior to withdrawal of LTG ranged from 3 months to 3.3 years. Five patients improved with withdrawal of LTG, and two required initiation of antipsychotic treatment due to severe psychosis. Improved behavioral profile was achieved within 1 month following LTG withdrawal in all responders (5/6).
CONCLUSIONS: Although the patient group described here represents a small proportion of TLE patients treated with LTG at the DVAMC, the association of psychosis with LTG appears likely. Frequent assessment of subtle changes in personality and affect should be a routine component of patient followup after intiation of any new anticonvulsant. Prognosis for improvement after withdrawal of AED remains good, even if the symptoms have been present for months to years.