Newer antiepileptic drugs in the management of agitation/aggression in patients with dementia or developmental disability.
OBJECTIVE
To assess the potential role of newer antiepileptic drugs (AEDs) in the management of agitation/aggression in patients with dementia or developmental disability.


METHODS
A MEDLINE/PUBMED search (1986-May 2007) was conducted to identify pertinent English language studies of six newer AEDs, as well as carbamazepine and valproate, in the management of agitation/aggression.


METHODS
All studies evaluating any aspect of management of agitation/aggression, emphasizing those associated with dementia or developmental disability.


RESULTS
Pharmacotherapy of agitation/aggression in these two patient groups remains an underexplored area. Carbamazepine and valproate have a reasonable, readily available evidence base, and preliminary recommendations regarding their use in these two patient groups. The most published data with newer AEDs involve gabapentin, followed by topiramate. Even so, the literature regarding newer AEDs is modest in volume.


CONCLUSIONS
Based on current data, gabapentin, oxcarbazepine, and topiramate are qualitatively similar in efficacy to carbamazepine/valproate in the management of agitation/aggression. However, studies-to-date in this field have had, in the main, numerous design flaws. In considering use of newer AEDs, the clinician needs to be aware of potential adverse events that are unique to these agents or infrequently seen with older AEDs (e.g., hyponatremia with oxcarbazepine, and acute myopia and angleclosure glaucoma, urinary tract stones, and cognition difficulties with topiramate). In addition, there is an extensive literature documenting that newer AEDs can precipitate new-onset or worsen existing behavioral disorders, including agitation/aggression.
Guay
David R P
DR
Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota 55455, USA. guayx001@umn.edu
D000374:Aggression / Q000187:drug effects*; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003704:Dementia / Q000188:drug therapy*; D002658:Developmental Disabilities / Q000188:drug therapy*; D006801:Humans; D007508:Irritable Mood / Q000187:drug effects; D016896:Treatment Outcome
D000927:Anticonvulsants