托吡酯致精神行为不良反应案例报道及文献分析

Topiramate-induced psychiatric and behavioral adverse reactions:a case report and literature analysis

目的:分析托吡酯致精神行为不良反应(PBAR)的临床特点、预后及机制。方法:结合1例托吡酯致PBAR,检索1999年1月至2020年1月国内外公开发表的托吡酯致PBAR的文献报道,案例报道对患者性别、年龄、原发病、托吡酯用药剂量、PBAR出现的时间及临床表现等信息进行提取和分析,临床研究从研究类型、研究人群及主要发现进行分析和总结。结果:共收集到符合纳入标准的文献包括个案或病例系列报道7篇及临床对照研究10篇,案例报道涉及患者12例,年龄19~62岁,平均年龄为(38.6±14.6)岁,发生PBAR时的日剂量为50~500 mg,主要表现有幻听或幻觉、妄想、焦虑、易激惹、偏执性行为及攻击性行为等。而临床研究表明,PBAR的发生率和临床特征不仅取决于既往的精神病史,还取决于年龄、性别、癫痫类型以及托吡酯剂量。结论:临床使用托吡酯需密切监测PBAR,症状出现后及时减量、停药,以确保用药安全有效。

Objectives: To analyze the clinical characteristics,prognosis and mechanism of topiramateinduced psychiatric and behavioral adverse reactions (PBAR).Methods: Based on one case of topiramate-induced PBAR,the literature on PBAR caused by topiramate published in domestic and foreign academic journals from January 1999 to December 2019 was reviewed and analyzed.For case reports the information of the patient’s gender,age,primary disease,topiramate dosage,time of PBAR appearance and clinical manifestations were extracted and analyzed.Clinical studies were analyzed and summarized from the study type,study population,and main findings.Results: A total of 7 case series reports and 10 clinical controlled studies that met the inclusion criteria were collected.The case reports involved 12 patients,aged 19 ~ 62 years (mean age 38.6 ± 14.6),and the daily dose at the time of PBAR was 50 to 500 mg.The clinical manifestations mainly included auditory hallucinations,hallucinations,anxious delusions,irritability,paranoid behavior,and aggressive behavior.Clinical studies showed that the incidence and clinical characteristics of PBAR depend not only on previous psychiatric history,but also on age,gender,type of epilepsy,and topiramate dose.Conclusion: PBAR caused by topiramate should be carefully monitored in clinical practice,and timely reduction and withdrawal should be taken after symptoms appear to ensure safe and effective medication.