Abstract
Carbamazepine and oxcarbazepine are used for behavioral disorders following organic diseases. After severe acquired brain injury, patients may develop frontal symptoms. In our neurological rehabilitation routine, oxcarbazepine is used for better safety over carbamazepine, although its efficacy is not clarified. We aimed to improve knowledge on this use of oxcarbazepine, by probing clinical factors associated with response. We retrospectively examined the clinical records of our patients, collecting clinical variables and outcomes of efficacy, both clinician-rated and caregiver/self-rated. We described the distribution of clinical variables and examined their associations via logistic regressions. Patients in our cohort were predominantly pediatric, with frontal lobe damage and irritable/reactive. With an oxcarbazepine median dose of 975 mg, almost half of patients improved. We found several clinical factors associated with clinician-rated efficacy: absence of frontal damage and absence of irritability/reactivity symptoms; clinical factors associated with caregivers/patients-rated efficacy were: higher DRS score at baseline and higher patient age. In this retrospective study, we observed that oxcarbazepine was differentially efficacious in patients with specific characteristics. Our study could not examine drug therapy separately from neuropsychological therapy, nor the influence of dose. Our associative results should be verified experimentally, also assessing causality and establishing dose-related efficacy and safety.
Highlights
Following severe acquired brain injury, many patients continue to experience major cognitive and behavior problems after physical recovery; these in turn affect rehabilitation negatively and have social consequences [1].In cases that require pharmacological treatment, options include psychiatric drugs, from antipsychotics to mood stabilizing anticonvulsant and sedatives, used off-label and not thoroughly tested for efficacy and safety [2].Among these drugs, anticonvulsants have gained momentum as alternatives and adjuncts to antipsychotics and lithium in the treatment of behavior disorders due to affective/schizoaffective disorders
Due to the presence of a brain injury not fully recovered, a formal diagnosis of conduct disorder or oppositional-defiant disorder was not made until discharge; the details of behavioral disorders were reported on clinical files and monitored; (5) having a Clinical Global Impression-Improvement (CGI-I) rating of behavioral symptoms, by which improvement is defined as CGI-I less than 3 on a scale of 1 to 7; (6) having the referring physician opt for pharmacological treatment of behavioral disorders with oxcarbazepine
We assembled a retrospective cohort of 46 patients treated with oxcarbazepine for behavioral disorders; of these, 12 were children, 18 adolescents, and 16 adults
Summary
In cases that require pharmacological treatment, options include psychiatric drugs, from antipsychotics to mood stabilizing anticonvulsant and sedatives, used off-label and not thoroughly tested for efficacy and safety [2]. Among these drugs, anticonvulsants have gained momentum as alternatives and adjuncts to antipsychotics and lithium in the treatment of behavior disorders due to affective/schizoaffective disorders. Carbamazepine was effective at improving endogenous mania in patients with organic psychoses and appeared more effective in patients with mixed mania, rapid cycling, and “non-classical” bipolar disorders [4,5]. Carbamazepine appears to be a drug of choice in the treatment of personality disorder [6,7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
