PDF(Pubmed)
Abstract：
Managing epilepsy in the context of intellectual disability can be complicated as this population is known to have higher rates of drug resistance and sensitivity to side effects of antiseizure medications (ASMs). Perampanel is a novel ASM recently approved as an adjunctive treatment for drug resistant focal seizures. It carries a black-box warning for serious psychiatric and behavioral adverse reactions of aggression, irritability, et cetera. However, psychosis is a seldom reported side effect of perampanel. We herein describe a case of a 15-year-old girl with moderate intellectual disability who presented with refractory seizures managed successfully after using perampanel. Around 2 months later, she developed psychosis and aggression. The patient\'s history lacked any significant family or personal history of mental illness. Managing psychotic symptoms was difficult in this case; as perampanel was needed for proper seizure control, and both psychosis and seizures were severe and significantly endangering the patient and people around her. Thus, symptoms were addressed by adding a low-dose risperidone, an atypical antipsychotic. This paper highlights the importance of pre-treatment counselling and monitoring for the emergence of psychiatric side effects including the rarely occurring psychosis while using perampanel, particularly in highly sensitive patients, e.g., those with intellectual disability. We also emphasize on the importance of accurate weighing of risks and benefits while managing psychosis as an adverse event to ASMs in the background of drug-resistant epilepsy.
摘要：
在智力障碍的情况下管理癫痫可能很复杂，因为已知该人群对抗癫痫药物（ASM）的副作用具有较高的耐药性和敏感性。Perampanel是一种新型的ASM，最近被批准为耐药性局灶性癫痫发作的辅助治疗。它带有黑匣子警告，警告严重的精神和行为攻击行为不良反应，烦躁，等等。然而,精神病是一个很少报道的副作用的perampanel。我们在此描述了一例患有中度智力障碍的15岁女孩，该女孩在使用perampanel后成功治疗了难治性癫痫发作。大约两个月后，她有精神病和攻击性.患者的病史没有任何重要的家庭或个人精神病史。在这种情况下，管理精神病症状很困难；因为需要潘帕内尔来正确控制癫痫发作，精神病和癫痫发作都很严重，严重危及患者和她周围的人。因此，通过添加低剂量利培酮来解决症状，非典型抗精神病药.本文强调了治疗前咨询和监测精神副作用的出现的重要性，包括使用perampanel时很少发生的精神病，特别是在高度敏感的患者中，例如，那些智力残疾的人。我们还强调准确衡量风险和益处的重要性，同时将精神病作为耐药性癫痫背景下ASM的不良事件进行管理。
