抗发作药物在的精神和行为副作用
Stanley Lyndon1,2,3, Barbara A Dworetzky4,5, Gaston Baslet4,6,7,8
1Harvard Medical School, 60 Fenwood Rd, Boston, MA, 02115, USA. slyndon@bwh.harvard.edu.
Journal of neurology
|December 23, 2025
概括
抗发作药物 (ASM) 的精神和行为副作用 (PBSE) 差异很大. 处方ASM的风险分层方法可以减轻PBSE,并保护患者的心理健康.
科学领域:
- 神经科学是一个神经科学.
- 精神病学是一个精神病学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 治疗涉及抗发作药物 (ASM) 与潜在的精神和行为副作用 (PBSEs).
- 当代证据对患有的成年人ASM的PBSEs需要合成指导临床实践.
研究的目的:
- 在成人患者中审查与ASM相关的PBSE现有证据.
- 根据PBSE风险制定选择,监测和切换ASM的实际指南.
主要方法:
- 从1990年到2025年对主要数据库 (PubMed,Embase,Web of Science,Cochrane) 和监管文件进行了全面的叙事审查.
- 包括随机试验,观察性研究,药监数据和PBSE的机制研究.
- 开发和应用ASM (非常低到非常高的行为风险) 的风险分级分类.
主要成果:
- 在28个ASM中,PBSE负担有显著的变化, levetiracetam,perampanel,felbamate和stiripentol显示出更高的风险 (易怒,攻击性).
- 卡巴马泽平,埃索苏西米德,拉克萨米德,牛卡马泽平,芬伊托因,普雷加巴林和普里米显示出较低的行为责任,其中一些具有情绪稳定作用.
- 增加PBSE风险的因素包括多疗法,快速定位,更高剂量,先前存在的精神疾病,智力障碍和社会剥夺. 这些机制包括AMPA受体调节,GABA强化,叶酸枯竭和NMDA对抗.
结论:
- PBSEs通常是可预测,可管理和可逆的.
- 风险分层的处方策略,优先考虑单一治疗,使用易受伤害的患者的情绪友好药物,补充叶酸作为诱导剂,及早停止违规ASM,可以在不影响控制的情况下保持心理健康.
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