Interventions for psychotic symptoms concomitant with epilepsy

Farooq S, Sherin A

Published Online:

March 16, 2011

Little evidence to inform the treatment of psychosis in people with epilepsy.

There is substantial evidence that people suffering from epilepsy have an increased risk of suffering from psychotic symptoms. These symptoms sometimes occur soon after or before the epileptic fits but in some cases can persist for a much longer time, even in the absence of seizures. The management of those suffering from psychosis related to epilepsy is complicated by the fact that most of the drugs used for controlling the symptoms of psychotic disorders can interfere with the effective control of epilepsy and vice versa. Only one small trial met the inclusion criteria for this review. At present there is a lack of evidence to inform the treatment of psychosis in people with epilepsy and further randomized controlled trials are needed.

Abstract (click to read)

Background:

This is an updated version of the original Cochrane review published in Issue 4, 2008.

People suffering from epilepsy have an increased risk of suffering from psychotic symptoms. The psychotic syndromes associated with epilepsy have generally been classified as ictal, postictal and interictal psychosis. Anticonvulsant drugs have been reported to precipitate psychosis. Moreover, all antipsychotic drugs have the propensity to cause paroxysmal EEG abnormalities and induce seizures.

Objectives:

To evaluate the benefits of interventions used to treat clinically significant psychotic symptoms occurring in people with epilepsy with regard to global improvement, changes in mental state, hospitalization, behavior, quality of life, effect on the frequency of seizures and interaction with antiepileptic drugs.

Search strategy:

We searched the Trials Registers of the Cochrane Schizophrenia Group and the Cochrane Epilepsy Group (October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL, issue 4,The Cochrane Library 2010), MEDLINE (Ovid, 1950 to October week 2, 2010), EMBASE (1980 to 2006), PsycINFO (1872 to October 2010), CINAHL (1981 to October 2010) and BIOSIS Previews (October 2010).

Two review authors (SF and AS) independently inspected the citations identified from the search. We identified potentially relevant abstracts and assessed full papers for inclusion and methodological quality.

Selection criteria:

All randomized controlled trials comparing drugs, behavior therapy, cognitive behavior therapy or other non-pharmacological interventions used to relieve psychotic symptoms in people with epilepsy.

Data collection and analysis:

We planned to extract and analyze the data from all relevant studies using standardized methods. As only one study met the inclusion criteria, no meta-analysis was attempted.

Main results:

After independently assessing the abstracts and titles of 492 articles, we selected five relevant abstracts. Ultimately we found only one study meeting the inclusion criteria, which was available only as an abstract. This study compared the use of olanzapine (10 mg/day) with haloperidol (12 mg/day) in 16 patients suffering from schizophrenia-like psychosis of epilepsy (SLPE). Thirteen patients completed the study. Significant improvement was associated with use of olanzapine. We did not identify any study on psychosocial interventions in patients suffering from epilepsy and psychosis.

Authors' conclusions:

Only one randomized controlled trial was found which lacked the power to test the efficacy of antipsychotics in those suffering from psychosis concomitant with epilepsy.

Limited evidence from this small RCT suggests an improvement in psychotic symptoms, but not other outcome measures, with the use of an antipsychotic. The effects on seizure control are not well studied. Further trials are required to inform practice.

This record should be cited as:

Farooq S, Sherin A. Interventions for psychotic symptoms concomitant with epilepsy. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006118. DOI: 10.1002/14651858.CD006118.pub2

Assessed as up to date:

February 15, 2011

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Primary Review Group:

Epilepsy Group

Health topics:

Neurology > Epilepsy > Treatment for psychiatric symptoms in people with epilepsy

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Interventions for psychotic symptoms concomitant with epilepsy

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