EPA-1290 - Pharmacological Treatment of Interictal Psychoses in Patients with Epilepsy, a Systematic Review

Abstract

Introduction:

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.

Objectives:

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.

Aim:

The research question is: Which antipsychotic medication is effective and safe in the treatment of interictal psychosis?

Methods:

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.

Data extraction:

Study, patient, intervention characteristics

Quality assessment:

Cohort studies and Case control studies were assessed with the appropriate CASP (Critical Appraisal Skills Program) assessment tools.

Results:

The search yielded 206 articles. After final selection 6 articles remained. 3 prospective cohort studies, 1 case series and 2 case reports.

Conclusions:

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.