Clarion Psychiatric Center, 2 Hospital Dr, Clarion, PA 16214.
Department of Psychiatry & Behavioral Sciences, Nassau University Medical Center, East Meadow, New York, USA.
Prim Care Companion CNS Disord. 2020 Jul 30;22(4):19nr02502. doi: 10.4088/PCC.19nr02502.
To identify clinical characteristics common among epileptic patients prescribed levetiracetam who report suicidal ideation or who exhibit suicidal behavior. A case is also provided that highlights the need for increased vigilance for neuropsychiatric sequelae in fragile epileptic patients prescribed levetiracetam, especially post dosage adjustment.
PubMed was queried with no time limitation to December 2018 using a combination of controlled terms. Using the Boolean operators "AND" and "OR," the authors searched PubMed for case reports and case series on levetiracetam-related suicidal behavior. The search terms used were [levetiracetam] OR [Keppra] AND in combination with suicidal, suicide, suicidal ideation, suicide attempt, and suicidality.
Relevant English-language human studies on levetiracetam and its effect on suicidal behavior were included. The search terms generated 78 results from the databases. After excluding all duplicates and applying the inclusion and exclusion criteria, a total of 14 clinical studies were retained for review.
Two reviewers independently extracted relevant data and assessed the methodological quality of each study.
The included studies reveal a number of risk factors for suicide ideation, suicide-related behavior, and suicide attempt among individuals taking levetiracetam. These risk factors include a prior psychiatric disorder, a history of traumatic brain injury, a history of substance use disorder, and a structural brain abnormality. Patients with these risk factors constitute a specific subgroup of patients with epilepsy who have an increased vulnerability to suicidal ideation or behavior if prescribed levetiracetam. These patients should, therefore, be monitored closely.
Suicidal behavior in epileptic patients appears to be multifactorial in etiology. Psychiatric disorders are more prevalent in epileptic patients than in the general population and contribute to this risk. In spite of the high risk of suicidal behavior with the use of antiepileptic drugs, studies have shown that the benefits of anticonvulsant therapy often outweigh the risks. Nevertheless, timely consultation with a psychiatrist is invaluable in the care of these patients, particularly those with multiple risk factors, as in the index case. The risk of suicidality should be balanced with the risk of uncontrolled seizures. Specifically, in the case of levetiracetam, it is important to be aware of the subgroup of individuals with prior severe psychiatric illness, a history of traumatic brain injury, or a history of substance use disorder who might be at an increased risk of developing suicide-related behavior and suicidal ideations once levetiracetam is started.
确定报告自杀意念或表现出自杀行为的开左乙拉西坦的癫痫患者的临床特征。本文还提供了一个案例，强调了需要提高对开左乙拉西坦治疗的脆弱癫痫患者的神经精神后遗症的警惕性，尤其是在调整剂量后。
无时间限制地在 2018 年 12 月之前在 PubMed 上进行了查询，使用了受控术语的组合。作者使用布尔运算符“AND”和“OR”，在 PubMed 上搜索了与左乙拉西坦相关的自杀行为的病例报告和病例系列。使用的搜索词是 [左乙拉西坦] 或 [开浦兰] 与自杀、自杀、自杀意念、自杀企图和自杀倾向相结合。
纳入了关于左乙拉西坦及其对自杀行为影响的相关英语人类研究。这些搜索词从数据库中生成了 78 个结果。排除所有重复项并应用纳入和排除标准后，共保留了 14 项临床研究进行综述。
两名审查员独立提取相关数据，并评估了每项研究的方法学质量。
纳入的研究揭示了在服用左乙拉西坦的个体中出现自杀意念、自杀相关行为和自杀企图的一些风险因素。这些风险因素包括先前的精神障碍、创伤性脑损伤史、物质使用障碍史和结构性脑异常。具有这些风险因素的患者构成了癫痫患者中一个特定的亚组，如果开左乙拉西坦，他们更容易出现自杀意念或行为。因此，这些患者应密切监测。
癫痫患者的自杀行为在病因上似乎是多因素的。精神障碍在癫痫患者中比在普通人群中更为普遍，这增加了这种风险。尽管抗癫痫药物使用会增加自杀行为的风险，但研究表明抗惊厥治疗的益处通常超过风险。尽管如此，及时咨询精神科医生对于这些患者的护理是非常宝贵的，特别是对于那些有多重风险因素的患者，如索引病例。自杀风险应与未控制的癫痫发作风险相平衡。具体来说，在左乙拉西坦的情况下，重要的是要意识到，对于那些有既往严重精神疾病、创伤性脑损伤史或物质使用障碍史的个体，一旦开始使用左乙拉西坦，他们可能会增加出现与自杀相关的行为和自杀意念的风险。
