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Effectiveness of carbamazepine for benzodiazepine-resistant impulsive aggression in a patient with frontal

Tomoyuki Nagata1, Daisuke Harada, Kimiyoshi Aoki

  • 1Department of Psychiatry, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan. t.nagata@jikei.ac.jp

Psychiatry and Clinical Neurosciences
|December 18, 2007
PubMed

Insights

Carbamazepine effectively treated impulsive aggression and agitation in a patient resistant to benzodiazepines. This finding suggests carbamazepine as a potential treatment for similar benzodiazepine-resistant cases.

Area of Science:

  • Neurology
  • Neuroscience
  • Pharmacology

Background:

  • Anticonvulsants have been explored for treating impulsive aggression since the 1980s.
  • Moyamoya disease can lead to neurological complications, including frontal lobe infarction.
  • Frontal lobe infarction can manifest as irritability and agitation, impacting social and occupational functioning.

Observation:

  • A 50-year-old male patient presented with persistent irritability and agitation following a right ipsilateral frontal lobe infarction due to Moyamoya disease.
  • The patient's symptoms were refractory to two years of treatment with multiple benzodiazepine agents.
  • Conventional treatments failed to alleviate the patient's behavioral disturbances.

Findings:

  • Initiation of carbamazepine (CBZ) treatment at 200 mg resulted in a gradual reduction of the patient's irritability and agitation.
  • Carbamazepine demonstrated efficacy in managing symptoms that were unresponsive to benzodiazepines.
  • The patient experienced significant improvement in behavioral symptoms with carbamazepine therapy.

Implications:

  • Carbamazepine may offer a viable therapeutic option for benzodiazepine-resistant impulsive aggression.
  • This case highlights the potential of carbamazepine in managing aggression secondary to neurological conditions.
  • Further research into carbamazepine for refractory aggression is warranted, particularly in post-stroke or neurovascular disease populations.

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