Theochari Evangelia, Cock Hannah, Lozsadi Dora, Galtrey Clare, Arevalo Jan, Mula Marco
Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK.
Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Medical and Biomedical Education, St George's University of London, UK.
Epilepsy Behav. 2019 Jan;90:129-131. doi: 10.1016/j.yebeh.2018.11.032. Epub 2019 Jan 22.
This is a case series of 25 patients with drug-resistant epilepsy and psychiatric comorbidities who started on brivaracetam (BRV) at St George's University Hospitals and Frimley Health in London. Median BRV dose was 150 mg for a median follow-up period of 8 months. Twenty had focal epilepsy, four had generalized epilepsies, and one had unclassified epilepsy; 76% had mood disorders (either depression or bipolar disorder), 12% intellectual disabilities with autism spectrum disorder and challenging behavior, and 12% psychoses. Forty percent of patients presented at least 50% seizure reduction, but none of them became seizure-free. A total of 44% of patients discontinued BRV, 20% because of adverse events, 20% because of inefficacy, and 4% because of both. Depression was reported by 8%, aggressive behavior by 8%, while 4% reported both. A total of 91.6% had received levetiracetam (LEV) before, in whom LEV was discontinued because of psychiatric adverse events (PAEs) in half. Seventy-seven percent of patients who developed PAEs with LEV did not do so on BRV suggesting that BRV is better tolerated than LEV in complex patients with psychiatric comorbidities and that the synaptic vesicle glycoprotein 2A (SV2A) protein modulation is unlikely to be implicated in LEV-related PAEs.
这是一个关于25例耐药性癫痫合并精神疾病患者的病例系列，这些患者在伦敦的圣乔治大学医院和弗里姆利健康中心开始服用布立伏西坦（BRV）。BRV的中位剂量为150毫克，中位随访期为8个月。20例为局灶性癫痫，4例为全身性癫痫，1例为未分类癫痫；76%患有情绪障碍（抑郁症或双相情感障碍），12%患有智力残疾并伴有自闭症谱系障碍和挑战性行为，12%患有精神病。40%的患者癫痫发作减少至少50%，但无一例实现无癫痫发作。共有44%的患者停用BRV，20%是因为不良事件，20%是因为无效，4%是因为两者皆有。8%的患者报告有抑郁，8%报告有攻击性行为，4%报告两者皆有。共有91.6%的患者之前接受过左乙拉西坦（LEV）治疗，其中一半患者因精神科不良事件（PAEs）停用LEV。在使用LEV时出现PAEs的患者中，77%在使用BRV时未出现，这表明在合并精神疾病的复杂患者中，BRV的耐受性优于LEV，并且突触小泡糖蛋白2A（SV2A）蛋白调节不太可能与LEV相关的PAEs有关。
