Greetings from the new Editor‐in‐Chief

Abstract

It is now recognised that a significant percentage of patients with epilepsy have comorbid psychiatric disorders, and it is also a fact that many patients with epilepsy are prescribed psychotropic drugs. While in many cases the psychotropic drugs may be rationally prescribed, it seems to us that often these drugs are given without careful clinical consideration as to patient need, and sometimes without due regard to the relevant pharmacokinetics and pharmacodynamics. In view of these problems, under the umbrella of the ILAE Commission on Psychobiological Aspects of Epilepsy, we have brought together a group of experts to discuss these issues, and to draw up some guidelines, published here, to help clinicians with their choice of psychotropic drugs. Furthermore, we hope to help clinicians understand the mechanisms and interactions of these compounds, particularly with regard to antiepileptic drugs. The overlap between epilepsy, psychotropic drugs, and antiepileptic agents is further relevant in that some of the latter are known also to possess psychotropic properties, a theme that is also touched on in this supplement. However, this fact alone serves to remind us that psychotropic drugs and antiepileptic drugs are chemical compounds whose main action is to influence central nervous system neurotransmitter function; it is therefore not surprising that psychiatrists often prescribe antiepileptic drugs, and neurologists psychotropic drugs in their clinical practice. There are additional worries in prescribing psychotropic drugs for patients with epilepsy, which have to do particularly with their potential proconvulsive effect. However, many neurologists are also concerned about additional neurological complications that can arise from prescription, for example, dependency or the development of a movement disorder. Some of these issues are addressed in this supplement. In the past decade there have been many developments in neurology and in psychiatry that include the introduction of new drugs that modulate activity in the central nervous system. We have also seen considerable growth in the use of recreational psychotropic agents, which themselves are associated with neurological and psychiatric disorders. We have in this supplement produced an overview of these difficult but important clinical topics, which we hope will be useful not only for those epileptologists who deal with patients with epilepsy, but also for future research. We start out with a chapter on basic mechanisms; it lays the groundwork for the rest of the monograph. This is followed by chapters dealing with antidepressants, antipsychotics, and tranquillisers that are used in patients with epilepsy, with regard, in addition, to special groups, for example, the elderly. The complex areas of pharmacodynamic and pharmacokinetic interactions are then presented. We finish with a chapter that reminds us that it is not always appropriate to prescribe psychotropic medication, and that there are alternative ways of dealing with many behaviour disorders that arise in clinical practice. The Commission of Psychobiology is grateful to Italian colleagues for hosting the round table conference where these topics were so openly presented. Professor Trimble and the members of The Commission for the Psychobiology of Epilepsy are very grateful to the International League Against Epilepsy for their financial support of the commission and for their help with the publication of this supplement.