Interventions for psychotic symptoms concomitant with epilepsy

Area of Science:

• Neurology
• Psychiatry
• Clinical Pharmacology

Background:

• Epilepsy is associated with an increased risk of psychotic symptoms, including ictal, postictal, and interictal psychosis.
• Anticonvulsant medications can precipitate psychosis, while antipsychotics may induce seizures and EEG abnormalities.
• Understanding the interplay between epilepsy and psychosis is crucial for effective treatment.

Purpose of the Study:

• To assess the benefits of interventions for clinically significant psychotic symptoms in individuals with epilepsy.
• To evaluate effects on global improvement, mental state, hospitalization, behavior, quality of life, seizure frequency, and antiepileptic drug interactions.

Main Methods:

• A comprehensive search of multiple electronic databases was conducted for randomized controlled trials (RCTs) up to May 2008.
• Studies included interventions like drugs, behavior therapy, and cognitive behavior therapy for epilepsy-associated psychosis.
• Data extraction and quality assessment were performed by two independent reviewers.

Main Results:

• Only one small RCT met the inclusion criteria, comparing olanzapine to haloperidol in 16 patients with schizophrenia-like psychosis of epilepsy (SLPE).
• Olanzapine (10 mg/day) showed significant improvement in psychotic symptoms compared to haloperidol (12 mg/day).
• No studies on psychosocial interventions were identified, and the effects on seizure control remain under-researched.

Conclusions:

• The available evidence from one small RCT is insufficient to definitively assess antipsychotic efficacy in epilepsy patients with psychosis.
• Limited data suggest potential benefits of olanzapine for psychotic symptoms, but not other outcomes.
• Further robust clinical trials are necessary to guide treatment practices for this patient population.