Weintraub D, Buchsbaum R, Resor S R, Hirsch L J
Department of Neurology, Columbia University Comprehensive Epilepsy Center, New York, NY, USA.
Epilepsy Behav. 2007 Feb;10(1):105-10. doi: 10.1016/j.yebeh.2006.08.008. Epub 2006 Oct 31.
Psychiatric/behavioral side effects (PSEs) are common in patients taking antiepileptic drugs (AEDs). The objective of the study described here was to compare the PSE profiles of the newer AEDs.
We examined the charts of 1394 adult outpatients seen at the Columbia Comprehensive Epilepsy Center who had taken one of the newer AEDs. We compared the rate of AED-related PSEs in patients newly started on the newer AEDs both before and after controlling for non-AED predictors of PSEs.
Overall, 221 of 1394 (16%) patients experienced PSEs. The average rate of AED-related PSEs for a single AED was 8.4%, with 6.1% resulting in dosage change and 4.3% resulting in AED discontinuation. Significantly fewer PSEs were attributed to gabapentin (n=160, 0.6% incidence, P<0.001) and lamotrigine (n=547, 4.8% incidence, P<0.001), and significantly more PSEs were attributed to levetiracetam (n=521, 15.7% incidence, P<0.001; 8.8% discontinued LEV because of PSEs). Vigabatrin, felbamate, and oxcarbazepine were associated with similarly low rates of PSEs in many analyses but with fewer of patients. Tiagabine was associated with high PSE rates (similar to those for levetiracetam), but was used much less commonly at our center. Intermediate rates of PSEs were attributed to topiramate and zonisamide (both nonsignificant). Psychiatric history was the most significant nondrug predictor of AED-related PSEs (PSEs occurred in 23% of patients with a psychiatric history vs 12% of patients without such a history, P<0.001). The relative rates of AED-related PSEs were similar when controlling for non-AED predictors and when analyzing only patients on monotherapy.
There are significant differences between the newer AEDs in terms of their PSE profiles. Patients taking levetiracetan experience significantly more PSEs than average, and patients taking gabapentin and lamotrigine experience significantly fewer PSEs. Even with the medication with the highest rate of PSEs (levetiracetam), less than 10% of patients discontinued it because of PSEs. A past psychiatric condition is the most significant nondrug predictor of AED-related PSEs.
精神/行为副作用（PSEs）在服用抗癫痫药物（AEDs）的患者中很常见。本文所述研究的目的是比较新型AEDs的PSEs情况。
我们查阅了哥伦比亚综合癫痫中心1394例成年门诊患者的病历，这些患者服用过一种新型AEDs。我们比较了刚开始服用新型AEDs的患者在控制PSEs的非AED预测因素前后与AED相关的PSEs发生率。
总体而言，1394例患者中有221例（16%）出现了PSEs。单一AED与AED相关的PSEs平均发生率为8.4%，其中6.1%导致剂量改变，4.3%导致停用AED。归因于加巴喷丁（n = 160，发生率0.6%，P < 0.001）和拉莫三嗪（n = 547，发生率4.8%，P < 0.001）的PSEs明显较少，而归因于左乙拉西坦（n = 521，发生率15.7%，P < 0.001；8.8%因PSEs停用左乙拉西坦）的PSEs明显较多。在许多分析中，vigabatrin、非氨酯和奥卡西平与PSEs发生率同样较低，但涉及的患者较少。替加宾与高PSEs发生率相关（与左乙拉西坦相似），但在我们中心使用较少。托吡酯和唑尼沙胺的PSEs发生率中等（均无统计学意义）。精神病史是与AED相关的PSEs最显著的非药物预测因素（有精神病史的患者中23%出现PSEs，无此类病史的患者中为12%，P < 0.001）。在控制非AED预测因素时以及仅分析接受单药治疗的患者时，与AED相关的PSEs相对发生率相似。
新型AEDs在PSEs情况方面存在显著差异。服用左乙拉西坦的患者出现的PSEs明显多于平均水平，而服用加巴喷丁和拉莫三嗪的患者出现的PSEs明显较少。即使是PSEs发生率最高的药物（左乙拉西坦），因PSEs停用的患者也不到10%。既往精神疾病是与AED相关的PSEs最显著的非药物预测因素。
