Epilepsy, Antiepileptic Drugs, and Aggression: An Evidence-Based Review

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• Antiepileptic drugs (AEDs) are vital for epilepsy management but can cause adverse effects.
• Aggressive behaviors, including aggression, agitation, and irritability, are reported in a subset of epilepsy patients on AEDs.
• These behaviors are often interictal and may be linked to comorbidities or AED treatment.

Purpose of the Study:

• To provide a comprehensive, evidence-based review of aggression in epilepsy patients, focusing on AED treatment.
• To summarize current understanding of aggression associated with AEDs in both adults and pediatric populations.
• To identify neurotransmitter systems and brain regions implicated in epilepsy and aggression.

Main Methods:

• Systematic literature search to identify relevant publications on aggression and AEDs.
• Evidence-based review of aggression during AED treatment, including adverse event reporting.
• Analysis of data on aggression-related behaviors associated with specific AEDs.

Main Results:

• Aggression is an uncommon side effect of AEDs, rarely seizure-related, and often interictal.
• Neurotransmitter systems (GABA, glutamate, serotonin, dopamine, noradrenaline) and brain regions (hippocampus, amygdala, prefrontal cortex, etc.) are implicated.
• Most evidence stems from adverse event reports; controlled studies on AEDs and aggression are limited.

Conclusions:

• A history of aggression/anger propensity should be routinely assessed in epilepsy patients.
• The presence of such a history does not contraindicate AED use but warrants caution with specific drugs.
• AEDs implicated in aggression should be used cautiously in susceptible individuals.