Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust and University of Birmingham, Birmingham, UK.
J Clin Psychopharmacol. 2012 Jun;32(3):362-75. doi: 10.1097/JCP.0b013e318253a186.
Patient tolerability is a significant limiting factor in the treatment of epilepsy and adverse effect profiles often determine drug retention rates. A full appreciation of the behavioral effects of a wide range of antiepileptic drugs (AEDs) is therefore essential to make informed treatment decisions. In this timely review, we highlight key alterations in mood, emotional experience, and other behavioral/psychiatric features, which can exert a crucial impact on patients' quality of life and well-being. With a view to prescribing both in general and in relation to more specific clinical characteristics, the evidence reviewed indicates that the incidence and characteristics of behavioral effects may be related to age, epilepsy type, the presence of learning disability, and previous psychiatric history. Medication parameters including dosage, titration rate, efficacy in controlling seizures, and concurrent AEDs can also contribute to the occurrence of behavioral effects. However, there are a number of limitations in drawing conclusions from the available literature. These include variation in study design, treatment group, and assessment tools that lead to difficulties comparing findings across studies, and problems with the consistency of available information relating to the study methodology. Future longitudinal studies assessing the impact of tolerance or developmental change on behavioral effects and specific studies comparing the effects of commonly prescribed agents across subgroups of patients with epilepsy will make an informative contribution to the available literature. A valuable outcome of further research may be the development of specific instruments that are sensitive to the behavioral effects associated with particular AEDs.
患者的耐受性是治疗癫痫的一个重要限制因素，不良反应谱通常决定了药物保留率。因此，全面了解各种抗癫痫药物（AEDs）的行为效应对于做出明智的治疗决策至关重要。在本次及时的综述中，我们强调了情绪、情感体验和其他行为/精神特征的关键变化，这些变化对患者的生活质量和幸福感有重要影响。为了进行一般和更具体的临床特征的处方，所审查的证据表明，行为效应的发生率和特征可能与年龄、癫痫类型、学习障碍的存在以及先前的精神病史有关。药物参数包括剂量、滴定速度、控制癫痫发作的疗效以及同时使用的 AEDs 也可能导致行为效应的发生。然而，从现有文献中得出结论存在一些限制。这些限制包括研究设计、治疗组和评估工具的差异，导致难以跨研究比较发现，以及与研究方法学有关的可用信息的一致性问题。未来的纵向研究评估耐受性或发育变化对行为效应的影响，以及比较癫痫患者亚组中常用药物的效果的具体研究，将为现有文献做出有价值的贡献。进一步研究的一个有价值的结果可能是开发出对特定 AEDs 相关行为效应敏感的特定仪器。
