A number of reports from the epilepsy literature suggest that gabapentin (GBP) may promote an improved sense of well-being independent of seizure reduction,66–70 but separating these two effects may be difficult. For example, in a recent open-label study, Harden et al.71 contended that epilepsy patients receiving GBP demonstrated significant reduction in depressive scores on a dysthymia rating scale independent of seizure reduction. Sample size was limited, however, and no significant differences were recorded on other depression or anxiety measures.

GBP has been demonstrated to be effective in treating mood disturbance in patients with partial epilepsy. Some studies showed increases in ratings of quality of life and well-being when patients were switched to this drug.72,73 The results of most studies have demonstrated minimal cognitive side effects associated with GBP.72–74

Open-label and case reports suggest that GBP has efficacy in treating mania75–78 and the depressive phase of bipolar disorder.79,80 Anecdotally, it may reduce agitation and improve sleep patterns in manic patients. It is being evaluated also in behavioral dyscontrol,81 agitation in senile dementia,82 anxiety states,83 social phobia,84 and self-injurious behaviors in neurologic syndromes.85 If further validated with clinical experience and more rigorous studies, these reports may have important relevance for the treatment of developmentally disabled (DD) epilepsy patients with comorbid psychiatric syndromes.

Several reports have cited the development or exacerbation of aggressive and agitated behaviors in children with epilepsy, most of whom had some degree of intellectual impairment.86,87 Clinicians, therefore, should watch carefully for behavioral side effects in treating DD patients with GBP. It may not be the optimal AED for treating some common seizure types encountered in DD epilepsy patients, such as absence and myoclonic and atonic seizures. Further, anecdotal experience in DD adults suggests that some patients may develop agitation.

The absence of protein binding or serious metabolic interactions gives GBP an excellent safety profile when used in combination therapy.

Adapted from: Ettinger AB, Barr WB, and Solomon SP. Psychotropic properties of antiepileptic drugs in patients with developmental disabilities. In: Devinsky O and Westbrook LE, eds. Epilepsy and Developmental Disabilities. Boston: Butterworth-Heinemann; 2001;219–230. With permission from Elsevier (www.elsevier.com).

Authored By: 
Sanford P. Solomon MD
William B. Barr MD
Alan B. Ettinger MD
I<
Reviewed By: 
Steven C. Schachter MD
on: 
Thursday, April 1, 2004