Jabeen Shaik Afshan, Gaddamanugu Padmaja, Cherian Ajith, Mridula Kandadai Mridula, Kumar Dasari Uday, Meena Angamuttu Kanikannan
Dept of Neurology, Nizam's Institute of Medical Sciences, Hyderabad 500 082 India.
J Popul Ther Clin Pharmacol. 2018 Jul 11;25(2):e1-e11. doi: 10.22374/1710-6222.25.2.1.
Objectives To study the clinical profile and outcome in patients with epilepsy who developed psychogenic non-epileptic seizures (PNES) associated with levetiracetam (LEV) use. Methods In this prospective observational study, conducted over 1 year, 13 patients with epilepsy and PNES, documented by video electroencephalogram (VEEG) while on LEV, were included. Those with past history of psychiatric illnesses were excluded. VEEG, high-resolution magnetic resonance imaging, neuropsychological and psychiatric evaluation were performed. Patients in Group I (07) were treated with psychotherapy, psychiatric medications and immediate withdrawal of LEV while, those in Group II (06) received psychotherapy, anxiolytics and LEV for initial 2 months after which it was stopped. Follow-up period was six months. There was subsidence of PNES on discontinuation of LEV in these patients. Results Mean (±SD) age of patients was 25 ± 12.28 years; there were 11 (84.62%) females. All were on antiepileptic agents which included LEV >1000 mg/day, except one. Mean dose of LEV was 1269.23 ± 483.71 mg/day. Three patient's scores were suggestive of depression or anxiety; one had both depression and anxiety. Eight patients had mood disorders; three had a history of emotional abuse or neglect. PNES subsided within 1-3 months and did not recur after withdrawal of LEV in any patient. Conclusion LEV can induce PNES in susceptible populations. Awareness of this association is crucial for timely withdrawal of triggering factor and appropriate management. This will reduce inadvertent additional prescription of antiepileptic agents.
目的 研究使用左乙拉西坦（LEV）后发生精神性非癫痫性发作（PNES）的癫痫患者的临床特征及预后。
方法 在这项为期1年的前瞻性观察研究中，纳入了13例在服用LEV期间经视频脑电图（VEEG）记录证实患有癫痫和PNES的患者。排除有精神疾病既往史的患者。进行了VEEG、高分辨率磁共振成像、神经心理学和精神科评估。第一组（7例）患者接受心理治疗、精神科药物治疗并立即停用LEV，而第二组（6例）患者在最初2个月接受心理治疗、抗焦虑药和LEV治疗，之后停用LEV。随访期为6个月。这些患者停用LEV后PNES症状缓解。
结果 患者的平均（±标准差）年龄为25±12.28岁；女性有11例（84.62%）。除1例患者外，所有患者均服用抗癫痫药物，其中包括每日服用量>1000 mg的LEV。LEV的平均剂量为1269.23±483.71 mg/天。3例患者的评分提示有抑郁或焦虑；1例患者既有抑郁又有焦虑。8例患者有情绪障碍；3例患者有情感虐待或忽视史。PNES在1 - 3个月内缓解，且所有患者停用LEV后均未复发。
结论 LEV可在易感人群中诱发PNES。认识到这种关联对于及时去除触发因素和进行适当管理至关重要。这将减少抗癫痫药物的意外额外处方。
