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.