Psychotic episodes during Zonisamide treatment

Abstract

Several articles have appeared over the last years devoted to mental side effects during zonisamide (ZNS) treatment. In this study, we were particularly interested in psychotic episodes. Seventy-four epileptic patients with a history of ZNS treatment were surveyed retrospectively over the period spanning 1 March 1984 to 30 June 1994. They were divided into two groups according to the presence or absence of psychotic episodes during ZNS treatment. We analysed various factors pertaining to psychotic episodes during ZNS treatment. Of the 74 patients 14 had psychotic episodes. We found that the incidence of psychotic episodes during ZNS treatment was several times higher than the previously reported prevalence of epileptic psychosis, and that the risk of psychotic episodes was higher in young patients. In 13 patients, psychotic episodes occurred within a few years of commencement of ZNS. In children, obsessive-compulsive symptoms appeared to be related to psychotic episodes. It is important to terminate ZNS as soon as possible if psychotic episodes develop and never restart, even if seizures become worse. It cannot definitely be proved that ZNS causes psychotic episodes, as information on mental side effects during ZNS monotherapy is scant, but it does appear likely that ZNS contributes to psychotic episodes during polytherapy.

Zonisamide discontinuation due to psychiatric and cognitive adverse events

“…8,17,18 There is little information available about risk factors for PAE or CAE in patients specifically taking ZNS. 9 One study evaluated factors associated with psychotic episodes in 14 of 74 (18.9%) ZNS users. 9 Male gender, history of neurotic symptoms, younger age, shorter duration of epilepsy, and shorter duration of ZNS treatment were associated with the development of psychosis.…”

“…9 One study evaluated factors associated with psychotic episodes in 14 of 74 (18.9%) ZNS users. 9 Male gender, history of neurotic symptoms, younger age, shorter duration of epilepsy, and shorter duration of ZNS treatment were associated with the development of psychosis. 9 This study has been criticized because of concerns that ZNS was not clearly the cause of the psychosis in the study patients.…”

“…1,6 -8 ZNS use has been correlated with a number of PAE including suicidal ideation and psychosis. 7,9 PAE are of particular concern because of the controversial Food and Drug Administration (FDA) decision in December 2008 requiring warnings of potential suicidality for all AEDs. 10,11 CAE associated with ZNS use include cognitive slowing, memory deficits, and language dysfunction in a manner comparable to topiramate (TPM).…”

“…1,[12][13][14] In spite of multiple reports linking PAE and CAE to treatment with ZNS, little information has been published regarding risk factors for these adverse events. 9 The objectives of this study were to 1) determine the incidence of PAE and CAE severe enough to result in the discontinuation of ZNS in a large clinical practice and 2) identify risk factors for PAE and CAE associated with the discontinuation of ZNS.…”

Psychiatrische Störungen bei Menschen mit Epilepsien und Intelligenzminderung

“…Das Auftreten einer toxischen Psychose korreliert nicht mit anderen Nebenwirkungen von Antiepileptika [33]. Psychosen sind in Einzelfällen auch bei anderen neuen Antiepileptika beschrieben [21].…”