Brodtkorb E, Sand T, Strandjord R E
Department of Neurology, Trondheim University Hospital, Norway.
Seizure. 1993 Sep;2(3):205-11. doi: 10.1016/s1059-1311(05)80129-3.
The mentally retarded often need concomitant antiepileptic and neuroleptic drug treatment. High doses of neuroleptic drugs may provoke seizures. Antiepileptic drugs may aggravate behavioural problems. The mutual influence of neuroleptic and antiepileptic drug treatment and the effect of seizure control were studied in 20 mentally retarded patients between 1980 and 1989. The treatment was tailored individually, aiming at the lowest effective dose. Carbamazepine was preferred to phenobarbital and phenytoin. The mean defined daily dose (DDD) of neuroleptics and antiepileptics was reduced by 64% and 5%, respectively. Changing the mean DDD of neuroleptics neither correlated significantly with seizure activity nor with the change of the mean DDD of the antiepileptics. Evidently, seizure control may be improved by small neuroleptic doses in some patients. In one patient, however, a non-convulsive status epilepticus was associated with the introduction of neuroleptics. The assumption that carbamazepine has a beneficial effect on behavioural problems was not supported. Apparently, changing the regime of antiepileptics contributed to less neuroleptic requirements, possibly through reduced side-effects and/or improved seizure control. When combining neuroleptics and antiepileptics, interactions should always be considered. The epileptogenic effect of small to standard doses of neuroleptic drugs should, however, not be overemphasized.
智力迟钝者常常需要同时接受抗癫痫药物和抗精神病药物治疗。高剂量的抗精神病药物可能会引发癫痫发作。抗癫痫药物可能会加重行为问题。1980年至1989年间，对20名智力迟钝患者的抗精神病药物和抗癫痫药物治疗的相互影响以及癫痫控制效果进行了研究。治疗方案是根据个体情况量身定制的，目标是使用最低有效剂量。卡马西平比苯巴比妥和苯妥英钠更受青睐。抗精神病药物和抗癫痫药物的平均限定日剂量（DDD）分别降低了64%和5%。抗精神病药物平均DDD的变化与癫痫活动以及抗癫痫药物平均DDD的变化均无显著相关性。显然，小剂量抗精神病药物在某些患者中可能会改善癫痫控制。然而，在一名患者中，引入抗精神病药物与非惊厥性癫痫持续状态有关。卡马西平对行为问题有有益作用这一假设未得到证实。显然，改变抗癫痫药物治疗方案可能会减少对抗精神病药物的需求，这可能是通过减少副作用和/或改善癫痫控制实现的。在联合使用抗精神病药物和抗癫痫药物时，应始终考虑相互作用。然而，不应过度强调小剂量至标准剂量抗精神病药物的致癫痫作用。
