Helmstaedter C, Fritz N E, Kockelmann E, Kosanetzky N, Elger C E
Department of Epileptology, University Hospital of Bonn, Bonn, Germany.
Epilepsy Behav. 2008 Oct;13(3):535-41. doi: 10.1016/j.yebeh.2008.05.012. Epub 2008 Jun 25.
The goals of this study were to observe behavioral changes in patients receiving levetiracetam (LEV), a newer antiepileptic drug (AED), and to answer the question of whether LEV exerts a specific effect on impulse control and aggression.
We asked 288 consecutive patients with epilepsy on LEV (90% polytherapy, mean dose=2689 mg) and 135 relatives whether LEV caused a positive or negative behavioral change. Forty-three patients on other AEDs served as a control group. Ratings were related to patient characteristics, efficacy, dose, drug load, bidirectional ratings of change in behavioral domains, and questionnaires on personality (Fragebogens zur Persönlichkeit bei zerebralen Erkrankungen) and impulsivity (Barratt Impulsiveness Scale-11).
LEV was rated as very effective by 40% of the patients. In contrast to only 9% of the controls, a considerable number of patients reported a behavioral change while taking LEV (12% very negative, 25% negative, 16% positive, 6% very positive). Negative ratings were due to loss of self-control, restlessness, sleep problems, and, most importantly, aggression. Positive ratings were due to increased energy, vigilance, and activation. Increases in psychomotor speed, concentration, and remote memory indicated subjectively experienced positive effects on cognition. The proxy reports indicated reliable self-reports. Reported change was not related to type of epilepsy, co-therapy, dose, drug load, or psychiatric history. Negative effects were, however, associated with poorer seizure control, mental retardation, indicators of an organic psychosyndrome, and nonplanning impulsiveness.
The results indicate that LEV exerts a dose-independent stimulating effect that can be positive or negative. Aggression is a prominent feature. Lack of efficacy, mental retardation, and presumably also pre-intake disposition (organic psychosyndrome, impulsivity) may be helpful in predicting whether additional activation under LEV will be positive or negative.
本研究的目的是观察服用新型抗癫痫药物（AED）左乙拉西坦（LEV）的患者的行为变化，并回答LEV是否对冲动控制和攻击性有特定影响的问题。
我们询问了288例连续服用LEV的癫痫患者（90%为联合治疗，平均剂量=2689毫克）和135名亲属，LEV是否引起了积极或消极的行为变化。43例服用其他AED的患者作为对照组。评分与患者特征、疗效、剂量、药物负荷、行为领域变化的双向评分以及关于人格（《脑疾病人格问卷》）和冲动性（巴雷特冲动性量表-11）的问卷有关。
40%的患者将LEV评为非常有效。与仅9%的对照组相比，相当多的患者报告在服用LEV时出现了行为变化（12%非常消极，25%消极，16%积极，6%非常积极）。消极评分归因于自我控制丧失、坐立不安、睡眠问题，最重要的是攻击性。积极评分归因于精力增加、警觉性和活跃度提高。精神运动速度、注意力和远期记忆的提高表明对认知有主观体验到的积极影响。代理报告表明自我报告可靠。报告的变化与癫痫类型、联合治疗、剂量、药物负荷或精神病史无关。然而，消极影响与癫痫控制较差、智力迟钝、器质性精神综合征指标和无计划冲动性有关。
结果表明，LEV发挥剂量无关的刺激作用，可能是积极的或消极的。攻击性是一个突出特征。疗效不佳、智力迟钝以及可能还有服药前的性格倾向（器质性精神综合征、冲动性）可能有助于预测LEV作用下的额外激活是积极的还是消极的。
