Sander J W, Hart Y M, Trimble M R, Shorvon S D
INSEG-Institute of Neurology, National Hospital for Neurology, London.
J Neurol Neurosurg Psychiatry. 1991 May;54(5):435-9. doi: 10.1136/jnnp.54.5.435.
We report a series of 14 cases of psychosis occurring in patients with severe intractable epilepsy, following the prescription of vigabatrin, a new antiepileptic drug. Nine patients had no previous history of psychosis. In eight patients the psychosis occurred following a change in the habitual pattern of seizure activity; in four it developed after a period of seizure freedom followed by a cluster of seizures, and in the other four patients an alternating psychosis was observed. In five patients there was no clear relationship to seizure pattern. Another patient developed psychosis after taking an overdose of between eight and 12 g of vigabatrin. A further three patients, who developed psychosis following vigabatrin withdrawal, were not included in this series. The mean dose at onset of the psychosis (excluding the patient who took an overdose) was 2580 mg, and the period from initiation of therapy to the onset of psychosis varied from five days to 32 weeks (and occurred 24 hours after the overdose of vigabatrin). In all cases the psychosis resolved, but necessitated the withdrawal of vigabatrin, except in the single patient who took the overdose. The mechanism of this behaviour change is unclear, but in some instances may reflect vigabatrin's powerful anti-epileptic action. This is clearly not the case for all patients. Vigabatrin should be started with caution in patients with severe epilepsy, particularly in the presence of a previous history of psychosis, and such patients should be carefully monitored.
我们报告了14例严重难治性癫痫患者在服用新型抗癫痫药物氨己烯酸后出现精神病的病例。9例患者既往无精神病病史。8例患者的精神病发生在癫痫发作活动的惯常模式改变之后；4例在癫痫发作停止一段时间后又出现一连串发作后发病，另外4例患者出现交替性精神病。5例患者的精神病与癫痫发作模式无明确关系。另有1例患者在过量服用8至12克氨己烯酸后出现精神病。本系列未包括另外3例在停用氨己烯酸后出现精神病的患者。精神病发作时的平均剂量（不包括过量服药的患者）为2580毫克，从开始治疗到精神病发作的时间从5天到32周不等（过量服用氨己烯酸后24小时发病）。所有病例的精神病均已缓解，但除过量服药的那例患者外，均需停用氨己烯酸。这种行为改变的机制尚不清楚，但在某些情况下可能反映了氨己烯酸强大的抗癫痫作用。显然并非所有患者都是如此。对于严重癫痫患者，尤其是既往有精神病病史的患者，应谨慎开始使用氨己烯酸，并且应对此类患者进行密切监测。
