ReviewJournal of neurology2025
Psychiatric and behavioural side effects of antiseizure medications in epilepsy.
Review in Journal of neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
- The effect of seizure-free period on seizure recurrence following antiseizure medication withdrawal: a systematic review and meta-analysis.Journal of neurology · 2026Pooled it
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo synthesise the contemporary evidence on psychiatric and behavioural side effects (PBSEs) of antiseizure medications (ASMs) in adults with epilepsy and provide actionable guidance for medication selection, monitoring and switching.
methodsWe performed a narrative review of PubMed, Embase, Web of Science, Cochrane Library and regulatory documents (January 1, 1990-September 30, 2025). Randomised trials, observational cohorts, pharmacovigilance databases and mechanistic studies reporting PBSEs were included. Data on PBSE frequency, discontinuation rates, risk factors and putative mechanisms were extracted and qualitatively integrated. Finally, we introduced and applied a pragmatic PBSE-based classification that grouped ASMs into Very Low, Low, Moderate, High and Very High behavioural-risk tiers to guide clinical decision-making.
resultsAcross 28 ASMs, PBSE burden spanned more than an order of magnitude under a composite risk-tiering method. Levetiracetam, perampanel, felbamate and stiripentol clustered at the upper end of the risk spectrum, with irritability and aggression dominating the clinical picture. Carbamazepine, ethosuximide, lacosamide, oxcarbazepine, phenytoin, pregabalin, and primidone exhibited the lowest behavioural liability and, in some cases, mood-stabilising properties. Polytherapy, rapid titration, higher doses, pre-existing psychiatric illness, intellectual disability, and social deprivation were associated with higher risk. Mechanisms leading to PBSEs converged on excessive AMPA-receptor modulation (including selective antagonism), broad GABAergic potentiation, folate depletion, NMDA antagonism, and pharmacokinetic interactions.
conclusionsPBSEs can often be anticipated, mitigated, and frequently reversed. A risk-stratified prescribing strategy-monotherapy first, enzyme-neutral or mood-friendly medications for vulnerable patients, folate supplementation for inducers, and early switch from offending agents-can safeguard mental health without compromising seizure control.
Indexed as
Identifiers
41432787What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.