Epilepsy, Antiepileptic Drugs, and Aggression: An Evidence-Based Review.
Epilepsy, Antiepileptic Drugs, and Aggression: An Evidence-Based Review.
复制标题
DOI：
10.1124/pr.115.012021
复制
发表时间：
2016-07
影响因子：
21.1
通讯作者：
Steinhoff BJ
中科院分区：
文献类型：
--
作者：
Brodie MJ;Besag F;Ettinger AB;Mula M;Gobbi G;Comai S;Aldenkamp AP;Steinhoff BJ
抗癫痫药物（AEDs）有许多好处，但也有许多副作用，包括一些癫痫患者的攻击性、躁动和易怒。本文全面总结了目前对癫痫患者攻击行为的理解，包括对AED治疗期间攻击行为的循证回顾。少数癫痫患者有攻击性。它很少与癫痫发作有关，但是间歇性的，有时作为复杂精神和行为合并症的一部分发生，有时与AED治疗有关。我们回顾了与癫痫和攻击有关的常见神经递质系统和大脑区域，包括GABA、谷氨酸、血清素、多巴胺和去甲肾上腺素系统以及海马体、杏仁核、前额叶皮层、前扣带皮层和颞叶。很少有对照临床研究使用行为测量来专门检查aed的攻击行为，大多数证据来自临床和观察性研究的不良事件报告。我们采用了系统的方法来识别相关的出版物，我们提出了一个全面的，以证据为基础的现有数据总结，围绕每一个目前可用的抗癫痫药在成人和儿童/青少年癫痫患者中的攻击相关行为。应定期向患者、家属和护理人员询问精神病史和攻击/愤怒倾向史；它的存在并不排除使用任何特定的aed，但在这种情况下，最可能涉及这些行为的aed应谨慎使用。
Antiepileptic drugs (AEDs) have many benefits but also many side effects, including aggression, agitation, and irritability, in some patients with epilepsy. This article offers a comprehensive summary of current understanding of aggressive behaviors in patients with epilepsy, including an evidence-based review of aggression during AED treatment. Aggression is seen in a minority of people with epilepsy. It is rarely seizure related but is interictal, sometimes occurring as part of complex psychiatric and behavioral comorbidities, and it is sometimes associated with AED treatment. We review the common neurotransmitter systems and brain regions implicated in both epilepsy and aggression, including the GABA, glutamate, serotonin, dopamine, and noradrenaline systems and the hippocampus, amygdala, prefrontal cortex, anterior cingulate cortex, and temporal lobes. Few controlled clinical studies have used behavioral measures to specifically examine aggression with AEDs, and most evidence comes from adverse event reporting from clinical and observational studies. A systematic approach was used to identify relevant publications, and we present a comprehensive, evidence-based summary of available data surrounding aggression-related behaviors with each of the currently available AEDs in both adults and in children/adolescents with epilepsy. A psychiatric history and history of a propensity toward aggression/anger should routinely be sought from patients, family members, and carers; its presence does not preclude the use of any specific AEDs, but those most likely to be implicated in these behaviors should be used with caution in such cases.