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.

Purpose of the Study:

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

Main Methods:

• Systematic search of multiple databases (Cochrane, MEDLINE, PsycINFO, etc.) up to March 2015.
• Included randomized controlled trials (RCTs) of drugs or non-pharmacological interventions for epilepsy-associated psychosis.
• Only one study met inclusion criteria; no meta-analysis was performed.

Main Results:

• One small RCT (16 participants) compared olanzapine to haloperidol for schizophrenia-like psychosis of epilepsy.
• Olanzapine showed significant improvement in psychotic symptoms compared to haloperidol.
• No studies on psychosocial interventions were identified.

Conclusions:

• The single RCT had insufficient power to definitively test antipsychotic efficacy in epilepsy-associated psychosis.
• Limited evidence suggests potential benefit of antipsychotics for psychotic symptoms, but not other outcomes.
• Further trials are necessary to clarify effects on seizure control and inform clinical practice.