[Abstract] Affective and behavioral dysfunction under antiepileptic drugs in epilepsy: Development of a new drug-sensitive screening tool

Highlights

  • Behavioral problems (e.g., depression) in epilepsy are common but usually of mild severity.
  • 30 AED-sensitive items were discerned from the BDI-I, NDDI-E, and FPZ.
  • Items were classified into six scales, constituting the new screening tool “PsyTrack”.
  • PsyTrack subscale scores differed as a function of drug load and presence of AEDs with negative psychotropic effects.
  • Generally, monotherapy seems to be favorable in terms of behavioral adverse effects.

Abstract

Objective

Behavioral problems and psychiatric symptoms are common in patients with epilepsy and have a multifactorial origin, including adverse effects of antiepileptic drugs (AEDs). In order to develop a screening tool for behavioral AED effects, the aim of this study was to identify behavioral problems and symptoms particularly sensitive to AED drug load and the presence/absence of AEDs with known negative psychotropic profiles.

Methods

Four hundred ninety-four patients with epilepsy were evaluated who had been assessed with three self-report questionnaires on mood, personality, and behavior (Beck Depression Inventory, BDI; Neurological Disorders Depression Inventory for Epilepsy extended, NDDI-E; and Fragebogen zur Persönlichkeit bei zerebralen Erkrankungen, FPZ). Drug-sensitive items were determined via correlation analyses and entered into an exploratory factor analysis for scale construction. The resulting scales were then analyzed as a function of drug treatment.

Results

Analyses revealed 30 items, which could be allocated to six behavioral domains: Emotional LabilityDepressionAggression/IrritabilityPsychosis & SuicidalityRisk- & Sensation-seeking, and Somatization. Subsequent analysis showed significant effects of the number of AEDs on behavior, as in Emotional Lability (F = 2.54, p = .029), Aggression/Irritability (F = 2.29, p = .046), Psychosis & Suicidality (F = 2.98, p = .012), and Somatization (F = 2.39, p = .038). Affective and behavioral difficulties were more prominent in those patients taking AEDs with supposedly negative psychotropic profiles. These effects were largely domain-unspecific and primarily manifested in polytherapy.

Conclusion

Drug-sensitive behavioral domains and items were identified which qualify for a self-report screening tool. The tool indicates impairments with a higher drug load and when administering AEDs with negative psychotropic profiles. The next steps require normalization in healthy subjects and the clinical validation of the newly developed screening tool PsyTrack along with antiepileptic drug treatment.

via Affective and behavioral dysfunction under antiepileptic drugs in epilepsy: Development of a new drug-sensitive screening tool – Epilepsy & Behavior

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