Psychiatric disorder comorbidity in patients with epilepsy (PWE) is very frequent with a mean percentage prevalence of up to 50% and even higher. Such a high frequency suggests that epilepsy and psychiatric disorders might share common pathological pathways. Various aspects contribute in making the matter very complex from a therapeutic point of view. Some antiseizure medications (ASMs), namely valproic acid, carbamazepine, and lamotrigine, have mood-stabilising effects and are routinely used for the treatment of bipolar disorder in patients who do not have epilepsy. Pregabalin and, to a lesser extent, gabapentin, exerts anxiolytic effects. However, several ASMs, in particular levetiracetam, topiramate, and perampanel, may contribute to psychiatric disorders, including depression, aggressive behaviour, and even psychosis. If these ASMs are prescribed, the patient should be monitored closely. A careful selection should be made also with psychotropic drugs. Although most of these can be safely used at therapeutic doses, bupropion, some tricyclic antidepressants, maprotiline, and clozapine may alter seizure threshold and facilitate epileptic seizures. Interactions between ASMs and psychotropic medication may make it difficult to predict individual response. Pharmacokinetic interactions can be assessed with drug monitoring and are consequently much better documented than pharmacodynamic interactions. Another aspect that needs a careful evaluation is patient adherence to treatment. Prevalence of non-adherence in PWE and psychiatric comorbidities is reported to reach values even higher than 70%. A careful evaluation of all these aspects contributes in optimizing therapy with a positive impact on seizure control, psychiatric wellbeing, and quality of life.

中文翻译：

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癫痫和精神合并症患者的治疗优化：要点

癫痫患者 (PWE) 精神疾病合并症非常常见，平均患病率高达 50% 甚至更高。如此高的频率表明癫痫和精神疾病可能具有共同的病理途径。从治疗的角度来看，各个方面都使问题变得非常复杂。一些抗癫痫药物 (ASM)，即丙戊酸、卡马西平和拉莫三嗪，具有稳定情绪的作用，通常用于治疗非癫痫患者的双相情感障碍。普瑞巴林和加巴喷丁在较小程度上发挥抗焦虑作用。然而，一些 ASM，特别是左乙拉西坦、托吡酯和吡仑帕奈，可能会导致精神疾病，包括抑郁症、攻击性行为，甚至精神病。如果开了这些 ASM，应对患者进行密切监测。精神药物也应谨慎选择。尽管其中大多数可以在治疗剂量下安全使用，但安非他酮、一些三环类抗抑郁药、马普替林和氯氮平可能会改变癫痫阈值并促进癫痫发作。ASM 和精神药物之间的相互作用可能会使预测个体反应变得困难。药代动力学相互作用可以通过药物监测进行评估，因此比药效学相互作用得到更好的记录。需要仔细评估的另一个方面是患者对治疗的依从性。据报道，不遵守 PWE 和精神合并症的患病率甚至超过 70%。对所有这些方面的仔细评估有助于优化治疗，对癫痫控制、精神健康和生活质量产生积极影响。