Title:Specific Patient Features Affect Antiepileptic Drug Therapy Decisions: Focus on Gender, Age, and Psychiatric Comorbidities
Volume: 23
Issue: 37
Author(s): Laura Rosa Pisani, Marina Nikanorova, Cecilie Johannessen Landmark, Svein Ivar Johannessen and Francesco Pisani*
Affiliation:
- Department of Clinical and Experimental Medicine, University of Messina,Italy
Keywords:
Gender, age, psychiatric comorbidities, drug choice, dosage optimization, seizures/epilepsy.
Abstract: Background: Patient features, apart from the type of seizures/epilepsy, affect markedly antiepileptic
drug (AED) choice and dosage. The present review focuses on gender, age and psychiatric comorbidities which
play a leading role in influencing antiepileptic treatment.
Methods: Reviews with large population of patients, controlled clinical trials, observational investigations, experimental
studies and experimental reviews of experimental data, where appropriated, were analysed and illustrated
to produce the most homogeneous indications possible. Different and also contradictory observations have
been highlighted to stimulate a critical approach to specific aspects.
Results: Women of childbearing age should avoid valproic (VPA), acid, since this drug doubles the risk of major
malformations and causes in the exposed offspring reduced intellectual development and disorders of autistic
spectrum. The drug is also associated with hormonal disorders, polycystic ovary and reduced fertility. Children
treated with valproic acid or phenobarbital can exhibit hyperactivity, nervousness and attention disorders. As a
consequence of increased drug elimination, younger children require higher doses as compared to adults and older
patients. Elderly patients treated with phenobarbital may face the risk of cognitive disorders and/or falls resulting
in bone fractures. Fractures are also facilitated by carbamazepine-induced osteoporosis. Psychiatric disorders are
frequently associated with epilepsy and evidence has been gained that common pathological steps underlie these
conditions. Depressed patients should avoid drugs like phenobarbital, topiramate, levetiracetam, zonisamide and
perampanel since these drugs can induce mood disorders. Although not conclusive, literature data indicate that
topiramate and levetiracetam and also tiagabine and vigabatrin, are associated with suicidal thought/behaviour.
Conversely, lamotrigine, carbamazepine, VPA and oxcarbazepine exert beneficial effects on mood. Bupropion,
clomipramine, amoxapine and maprotyline among antidepressants, and clozapine, olanzapine and quietapine
among antipsychotics have been observed to lower seizure threshold. Serum AED concentration monitoring is of
help in dosage adjustments, especially in very young children, in patients with cognitive decline and in patients
with psychiatric comorbidities.
Conclusions: A careful evaluation of the patient variables analysed in the present review is useful to personalize
and optimize AED therapy.
