Abstract
Psychiatric and behavioural side effects are common, undesirable effects associated with antiseizure medication use. Temporal lobe epilepsy is the most common focal epilepsy in adults and it is frequently associated with drug resistance. Patients with intractable epilepsy are more likely to have psychiatric and behavioural side effects when taking antiseizure medications and seem to be at higher risk for psychiatric comorbidities. Perampanel is a novel anti-seizure medication approved for focal and generalised epilepsies as add-on therapy. This is a 12-week short-term observational prospective study on people with focal epilepsy consecutively recruited from an Italian tertiary epilepsy centre, aimed to compare incidence and severity of psychiatric and behavioural side effects associated with perampanel use in patients with temporal lobe epilepsy as compared to other focal epilepsies. All patients received add-on perampanel according to indication and clinical judgement. Incidence and severity of psychiatric and behavioural side effects were rated by Neuropsychiatric Inventory Questionnaire. All patients enrolled answered the questionnaire before starting perampanel and after 12 weeks of treatment. We found no significant difference in terms of incidence and severity of psychiatric and behavioural side effects associated with perampanel in patients with temporal lobe epilepsy as compared to other focal epilepsies. In line with the literature, the most common adverse effects were “irritability” for both groups and “aggression” for patients with other focal epilepsies.
Highlights
Psychiatric disturbances are more common in people with epilepsy than in the general population [1]
We found no significant difference in terms of incidence and severity of psychiatric and behavioural side effects associated with PER in people with Temporal lobe epilepsy (TLE) as compared to other focal epilepsies
psychiatric and behavioural side effects (PBSEs) appeared in 19.7% of patients, in agreement with literature data, without significant difference between people with TLE (20.5%) and other focal epilepsies (18.5%)
Summary
Psychiatric disturbances are more common in people with epilepsy than in the general population [1]. People with epilepsy (PWE) may experience psychiatric and behavioural side effects (PBSEs) related to antiseizure medications (ASMSs), including depressed mood, anxiety, psychosis, obsession, personality traits, irritability, aggressive behaviour, and suicide [2, 3]. People with drug-resistant epilepsy (seizures failing to disappear with two or more ASMs) are more likely to have PBSEs when taking ASMs [4]. Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy and it is often associated with drug resistance [6]. In relation to psychiatric disturbances, a meta-analysis demonstrated that the estimated prevalence of psychosis was higher among individuals with TLE, implicating that the temporal lobe area may be a key brain region, sharing the pathophysiology of TLE and psychiatric disorders [7]. PER is a selective, non-competitive antagonist of α-amino-3-hydroxy-5-methyl4-isoxazolepropionic acid (AMPA)-type glutamate receptors on post-synaptic neurons and it is the first-in-class AMPA receptor antagonist which acts by reducing glutamatergic transmission [9–11]
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