Abstract
Aim: Anticonvulsant medications are frequently used in clinical practice to treat psychiatric disorders in children and adolescents, but the evidence for their efficacy is uncertain. We conducted a systematic review of published randomized controlled trials (RCT) that assessed the psychiatric benefit of anticonvulsants in patients under 18 years of age.Method: The Medline, Scopus, Web of Science, and ClinicalTrials.gov databases were systematically searched for peer-reviewed primary publications of RCTs with a minimum of 10 patients per treatment arm through December 2017.Results: Out of 355 identified non-duplicative publications, 24 met the inclusion criteria. Most RCTs were to treat bipolar disorder (n = 12) or manage recurrent aggression (n = 9). Few (n = 3) had both a multisite design and adequate statistical power. Valproate was the most frequently studied anticonvulsant (n = 15). Out of three placebo-controlled RCTs of valproate in bipolar disorder, none showed efficacy. In four RCTs, valproate was inferior to the antipsychotic risperidone. In several small, single-site RCTs, valproate and sulthiame were better than placebo for the management of recurrent aggression.Conclusions: Currently available RCTs do not support the efficacy of anticonvulsants as mood stabilizers in children. There is some preliminary evidence from small RCTs of the efficacy of some anticonvulsants in the control of aggression and behavioral dyscontrol in conduct disorder, autism, and intellectual disability.
Highlights
Anticonvulsant medications have been used for decades in the treatment of psychiatric disorders
We searched for English language, peer-reviewed publications that were the primary reports of randomized controlled trials (RCTs) testing the efficacy of anticonvulsants in the treatment of psychiatric disorders in children
A total of 24 publications, each constituting the primary report of a RCT of anticonvulsant efficacy in psychiatric disorder in children were identified
Summary
Anticonvulsant medications have been used for decades in the treatment of psychiatric disorders. It is postulated that the biochemical mechanisms underlying their anti-seizure activity can lead to stabilization of mood and behavior [1]. Valproate, carbamazepine, and lamotrigine have demonstrated efficacy as mood stabilizers in acute mania and/or as maintenance treatment of bipolar disorder to prevent recurrence [2,3,4,5]. Oxcarbazepine and topiramate are used, but without clear-cut evidence of efficacy [6,7,8]. Some anticonvulsants have anti-aggressive properties, and carbamazepine, oxcarbazepine, and phenytoin have been found to be effective in the management of recurrent impulsive aggression [9].
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