Abstract
This systematic review is to provide evidence for the guideline for the treatment of interictal psychosis in epilepsy for Kempenhaeghe, a categorical epilepsy treatment center in Heeze, the Netherlands. Life-time prevalence of psychosis in patients with epilepsy ranges from 2-7% of which 10-30% interictal. Typical and atypical antipsychotic drugs are widely used to treat. The combination with epilepsy, drug-interaction and the effect of anti-psychotic medication on the seizure threshold are complicating factors. Evidence for the efficacy of pharmacological treatment is lacking. The research question is: Which antipsychotic medication is effective and safe in the treatment of interictal psychosis? We searched in: Medline, Embase, Psychinfo and the Cochrane database. Two independent reviewers made a first selection from the titles and abstracts. If necessary the selection was made with the full text version. In case of disagreement, a third reviewer decided. Study, patient, intervention characteristics Cohort studies and Case control studies were assessed with the appropriate CASP (Critical Appraisal Skills Program) assessment tools. The search yielded 206 articles. After final selection 6 articles remained. 3 prospective cohort studies, 1 case series and 2 case reports. Anti-psychotic medication can be effective (grade 3) Possibly the dose needed can be lower. (grade 3) Possibly clozapine lowers the seizure threshold. (grade 3) No other anti-psychotics lower the seizure threshold (grade4) No anti-psychotic is especially effective (grade 4) There is no evidence for length of treatment. The review and the guideline will be presented.
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