Neuropsychiatric adverse events with anti-seizure medications in patients with epilepsy: A systematic review and meta-analysis.
Kunal Kumar, Sweta Roy, Himanshu Kaushal et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis synthesized observational evidence on neuropsychiatric adverse events (NPAEs) associated with anti-seizure medications (ASMs) in people with epilepsy. Across 18 studies, memory disorders and depression were reported across first-, second-, and third-generation ASMs, with rates varying by generation. No statistically significant difference in psychosis risk was found between first- and second-generation ASMs (RR 0.77; 95% CI 0.34-1.76). Topiramate had the strongest reported association with psychosis (OR 3.07; 95% CI 2.55-3.71); findings for other medication-specific outcomes were based on individual studies.
Key findings
- Memory disorders were reported in 8.7%, 3.8%, and 6.2% of participants receiving first-, second-, and third-generation ASMs, respectively.
- Depression was reported in 2.3%, 1.2%, and 3.0% of participants receiving first-, second-, and third-generation ASMs, respectively.
- Psychosis risk did not differ significantly between first- and second-generation ASMs (RR 0.77; 95% CI 0.34-1.76).
- Topiramate showed the strongest association with psychosis risk (OR 3.07; 95% CI 2.55-3.71).
Why it matters
NPAEs span behavioural, cognitive, mood, sleep, and psychotic outcomes, and reported risks vary across ASMs. Awareness of these potential effects can inform medication discussions and monitoring, while the observational evidence does not establish that ASMs caused the reported outcomes or provide precise comparative estimates for every drug.
What to keep in mind
The evidence is observational and subject to residual confounding, heterogeneous comparators and outcome definitions, and limited data on dose, duration, polytherapy, and newer ASMs.