Psychiatric Symptoms and Quality of Life in Patients with Drug- Refractory Epilepsy Receiving Adjunctive Levetiracetam Therapy
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background and Purpose Levetiracetam (LEV) is a new antiepileptic drug that has been found to be effective as an adjunctive therapy for uncontrolled partial seizures. However, the results of several studies suggested that LEV has negative psychotropic effects, including irritability, aggressiveness, suicidality, and mood disorders. We investigated the impact of adjunctive LEV on psychiatric symptoms and quality of life (QOL) in patients with drug-refractory epilepsy (DRE) and determined the risk factors provoking psychiatric adverse events. Methods A 24-week, prospective, open-label study was conducted. At enrollment, we interviewed patients and reviewed their medical charts to collect demographic and clinical information. They were asked to complete self-report health questionnaires designed to measure various psychiatric symptoms and QOL at enrollment and 24 weeks later. Results Seventy-one patients were included in the study, 12 patients (16.9%) of whom discontinued LEV therapy due to serious adverse events including suicidality. The risk factor for premature withdrawal was a previous history of psychiatric diseases (odds ratio 4.59; 95% confidence interval, 1.22-17.32). LEV intake resulted in significant improvements in Beck Anxiety Inventory score (p<0.01) and some domains of the Symptom Checklist-90-Revised, such as somatization (p<0.05), obsessive-compulsiveness (p<0.05), depression (p<0.05), and anxiety (p<0.05). These improvements were not related to the occurrence of seizure freedom. The Quality of Life in Epilepsy Inventory-31 overall score and subscale scores, such as seizure worry (p<0.01),overall QOL (p<0.05), emotional well-being (p<0.05), energy-fatigue (p<0.05), and social function (p<0.05), also improved. Conclusions Adjunctive LEV in patients with DRE is likely to improve psychiatric symptoms and QOL. Clinicians should be well aware of the psychiatric histories of patients to prevent them from developing serious adverse events related to LEV.
Abstract
Background and Purpose Levetiracetam (LEV) is a new antiepileptic drug that has been found to be effective as an adjunctive therapy for uncontrolled partial seizures. However, the results of several studies suggested that LEV has negative psychotropic effects, including irritability, aggressiveness, suicidality, and mood disorders. We investigated the impact of adjunctive LEV on psychiatric symptoms and quality of life (QOL) in patients with drug-refractory epilepsy (DRE) and determined the risk factors provoking psychiatric adverse events. Methods A 24-week, prospective, open-label study was conducted. At enrollment, we interviewed patients and reviewed their medical charts to collect demographic and clinical information. They were asked to complete self-report health questionnaires designed to measure various psychiatric symptoms and QOL at enrollment and 24 weeks later. Results Seventy-one patients were included in the study, 12 patients (16.9%) of whom discontinued LEV therapy due to serious adverse events including suicidality. The risk factor for premature withdrawal was a previous history of psychiatric diseases (odds ratio 4.59; 95% confidence interval, 1.22-17.32). LEV intake resulted in significant improvements in Beck Anxiety Inventory score (p<0.01) and some domains of the Symptom Checklist-90-Revised, such as somatization (p<0.05), obsessive-compulsiveness (p<0.05), depression (p<0.05), and anxiety (p<0.05). These improvements were not related to the occurrence of seizure freedom. The Quality of Life in Epilepsy Inventory-31 overall score and subscale scores, such as seizure worry (p<0.01),overall QOL (p<0.05), emotional well-being (p<0.05), energy-fatigue (p<0.05), and social function (p<0.05), also improved. Conclusions Adjunctive LEV in patients with DRE is likely to improve psychiatric symptoms and QOL. Clinicians should be well aware of the psychiatric histories of patients to prevent them from developing serious adverse events related to LEV.
참고문헌 (42)
- Park SP, "Differential effects of seizure control and affective symptoms on quality of life in people with epilepsy", EPILEPSY & BEHAVIOR, 18, pp.455~459, ACADEMIC PRESS INC ELSEVIER SCIENCE
- 임혜원, "Predictors of Suicidal Ideation in People with Epilepsy Living in Korea", Journal of Clinical Neurology, 6(2), pp.81~88 (2010), 대한신경과학회
- Cramer JA, "Epilepsy Impact Project Group. The impact of comorbid depression on health resource utilization in a community sample of people with epilepsy", Epilepsy Behav, 5, pp.337~342 (2004)
- Mula M, "Antiepileptic drugs and psychopathology of epilepsy: an update", Epileptic Disord, 11, pp.1~9 (2009)
- Berg AT, "Early development of intractable epilepsy in children: a prospective study", Neurology, 56, pp.1445~1452 (2001)
- Nilsson L, "Risk factors for suicide in epilepsy: a case control study", Epilepsia, 43, pp.644~651 (2002)
- Baker GA, "Quality of life of people with epilepsy: a European study", Epilepsia, 38, pp.353~362 (1997)
- Ketter TA, "Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders", Neurology, 53, pp.53~67 (1999)
- Cereghino JJ, "Levetiracetam for partial seizures: results of a double-blind, randomized clinical trial", Neurology, 55, pp.236~242 (2000)
- Heo K, "Efficacy and safety of levetiracetam as adjunctive treatment of refractory partial seizures in a multicentre open-label single-arm trial in Korean patients", Seizure, 16, pp.402~409 (2007)
- De Smedt T, "Levetiracetam: part II, the clinical profile of a novel anticonvulsant drug", CNS Drug Rev, 13, pp.57~78 (2007)
- Lynch BA, "The synaptic vesicle protein SV2A is the binding site for the antiepileptic drug levetiracetam", Proc Natl Acad Sci U S A, 101, pp.9861~9866 (2004)
- Muralidharan A, "Potential of levetiracetam in mood disorders: a preliminary review", CNS Drugs, 20, pp.969~979 (2006)
- Cramer JA, "A systematic review of the behavioral effects of levetiracetam in adults with epilepsy, cognitive disorders, or an anxiety disorder during clinical trials", Epilepsy Behav, 4, pp.124~132 (2003)
- Ciesielski AS, "Neuropsychological and psychiatric impact of add-on titration of pregabalin versus levetiracetam: a comparative short-term study", Epilepsy Behav, 9, pp.424~431 (2006)
- Mazza M, "Effect of levetiracetam on depression and anxiety in adult epileptic patients", Prog Neuropsychopharmacol Biol Psychiatry, 32, pp.539~543 (2008)
- Wu T, "Hung CC, et al. Clinical efficacy and cognitive and neuropsychological effects of levetiracetam in epilepsy: an open-label multicenter study", Epilepsy Behav, 16, pp.468~474 (2009)
- Hurtado B, "The impact of levetiracetam on challenging behavior", Epilepsy Behav, 8, pp.588~592 (2006)
- Weintraub D, "Psychiatric and behavioral side effects of the newer antiepileptic drugs in adults with epilepsy", Epilepsy Behav, 10, pp.105~110 (2007)
- Bootsma HP, "Levetiracetam in clinical practice: long-term experience in patients with refractory epilepsy referred to a tertiary epilepsy center", Epilepsy Behav, 10, pp.296~303 (2007)
- Mula M, "Suicidal ideation in epilepsy and levetiracetam therapy", Epilepsy Behav, 11, pp.130~132 (2007)
- Mula M, "Are psychiatric adverse events of antiepileptic drugs a unique entity? A study on topiramate and levetiracetam", Epilepsia, 48, pp.2322~2326 (2007)
- Helmstaedter C, "Positive and negative psychotropic effects of levetiracetam", Epilepsy Behav, 13, pp.535~541 (2008)
- Labiner DM, "Effects of lamotrigine compared with levetiracetam on anger, hostility, and total mood in patients with partial epilepsy", Epilepsia, 50, pp.434~442 (2009)
- de la Loge C, "Assessment of behavioral and emotional functioning using standardized instruments in children and adolescents with partial-onset seizures treated with adjunctive levetiracetam in a randomized, placebo-controlled trial", Epilepsy Behav, 18, pp.291~298 (2010)
- Andersohn F, "Use of antiepileptic drugs in epilepsy and the risk of self-harm or suicidal behavior", Neurology, 75, pp.335~340 (2010)
- Berg AT, "Early development of intractable epilepsy in children: a prospective study", Neurology, 56, pp.1445~1452 (2001)
- Kim ZS, "Two- and four-subtest short forms of the Korean-Wechsler Adult Intelligence Scale", Seoul J Psychiatry, 19, pp.121~126 (1994)
- Rhee MK, "A standardization study of Beck Depression Inventory (II): Korean version (K-BDI): validity", Korean J Psychopathol, 4, pp.96~104 (1995)
- YookSP, "A clinical study on the Korean version of Beck Anxiety Inventory: comparative study of patient and non-patient", Korean J Clin Psychol, 16, pp.185~197 (1997)
- Kim JH, "The standardization study of symptom checklist-90-revision in Korea III", Mental Health Res, 2, pp.278~311 (1984)
- Shin MS, "A study of suicidal ideation among high school students : the structural relation among depression, hopelessness, and suicidal ideation", Korean J Clin Psychol, 9, pp.1~19 (1990)
- Yoo HJ, "The reliability and validity of Korean QOLIE-31 in patients with epilepsy", J Korean Epilepsy Soc, 6, pp.45~52 (2002)
- "Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy", Epilepsia, 489~501 (1981)
- Otoul C, "Meta-analysis and indirect comparisons of levetiracetam with other second-generation antiepileptic drugs in partial epilepsy", Clin Neuropharmacol, 28, pp.72~78 (2005)
- French J, "A systematic review of the safety profile of levetiracetam: a new antiepileptic drug", Epilepsy Res, 47, pp.77~90 (2001)
- Arroyo S, "Safety profile of levetiracetam", Epileptic Disord, 5(Suppl 1), pp.57~63 (2003)
- Harden C, "Safety profile of levetiracetam", Epilepsia, 42(Suppl 4), pp.36~39 (2001)
- Wolf P, "Acute behavioral symptomatology at disappearance of epileptiform EEG abnormality. Paradoxical or “forced” normalization", Adv Neurol, 55, pp.127~142 (1991)
- "Statistical Review and Evaluation: Antiepileptic Drugs and Suicidality"[URL]
- Birbeck GL, "Seizure reduction and quality of life improvements in people with epilepsy", Epilepsia, 43, pp.535~538 (2002)
- Schmitz B, "Effects of antiepileptic drugs on mood and behavior", Epilepsia, 47(Suppl 2), pp.28~33 (2006)