Arora Aryan, Prakash Priya, Rizzo Laura, Blackman Graham, David Anthony S, Rogers Jonathan P
Medical School, University College London, London, UK.
Division of Biosciences, University College London, London, UK.
Epilepsia. 2024 Dec;65(12):3425-3440. doi: 10.1111/epi.18123. Epub 2024 Oct 21.
Individuals with epilepsy are at risk of developing preictal, ictal, postictal and interictal psychoses. Antipsychotic drugs (APDs) are the main class of drugs used to treat psychosis and schizophrenia. The efficacy and safety of APDs as a treatment for epileptic psychosis is not well understood. This systematic review aimed to assess the effectiveness and adverse effects of APDs for treating psychosis in people with epilepsy. We adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched MEDLINE, Embase, PsycInfo, and AMED (Allied and Complementary Medicine) from database inception to June 20, 2023. We contacted experts in the field and performed citation searches to identify additional records. Title, abstract, full-text review, and data analysis were conducted in duplicate, with conflicts resolved by discussion among authors. Given the considerable heterogeneity of study designs, meta-analysis was not deemed appropriate; instead, the results were tabulated in a narrative synthesis. The Joanna Briggs Institute Risk of Bias tool and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework were used to assess study quality. We identified 13 studies with a total of 1180 participants. In the four case series included, the psychotic symptoms of 25 of 28 patients treated with APDs partially improved or fully resolved. Three of the four cohort studies reported an association between antipsychotic use and longer duration of psychotic episodes, two found similar results in both APD and non-APD groups, and two did not report control psychosis outcomes. When reported, seizure frequency was observed to remain unchanged or decrease following APD treatment. The evidence on the effectiveness of antipsychotics in the treatment of psychosis in epilepsy is inconclusive and may reflect confounding by indication. However, most studies suggest that antipsychotics were not associated with a marked worsening in seizure frequency. It remains unclear whether antipsychotics should be used in epilepsy, and well-controlled cohort studies and randomized controlled trials are necessary to draw definitive conclusions.
癫痫患者有发生发作前、发作期、发作后和发作间期精神病的风险。抗精神病药物（APD）是用于治疗精神病和精神分裂症的主要药物类别。APD作为治疗癫痫性精神病的疗效和安全性尚未得到充分了解。本系统评价旨在评估APD治疗癫痫患者精神病的有效性和不良反应。我们遵循PRISMA（系统评价和Meta分析的首选报告项目）指南。我们检索了MEDLINE、Embase、PsycInfo和AMED（补充与替代医学）数据库，检索时间从建库至2023年6月20日。我们联系了该领域的专家并进行了文献追溯检索以识别其他记录。标题、摘要、全文审查和数据分析均进行了两遍，如有冲突通过作者间讨论解决。鉴于研究设计存在相当大的异质性，未认为进行Meta分析合适；相反，结果以叙述性综合的形式制成表格。使用乔安娜·布里格斯研究所偏倚风险工具和GRADE（推荐分级评估、制定和评价）框架来评估研究质量。我们识别出13项研究，共有1180名参与者。在纳入的4个病例系列中，28例接受APD治疗的患者中有25例的精神病症状部分改善或完全缓解。4个队列研究中有3个报告了使用抗精神病药物与精神病发作持续时间延长之间的关联，2个在APD组和非APD组中均发现了类似结果，2个未报告对照精神病结局。当报告时，观察到APD治疗后癫痫发作频率保持不变或降低。抗精神病药物治疗癫痫性精神病有效性的证据尚无定论，可能反映了指征性混杂因素。然而，大多数研究表明抗精神病药物与癫痫发作频率的显著恶化无关。抗精神病药物是否应用于癫痫患者仍不清楚，需要进行严格对照的队列研究和随机对照试验才能得出明确结论。
