A new study conducted in Kilifi has revealed that patients on multiple anti-seizure medications, a treatment approach known as polytherapy, are at a higher risk of developing mental health problems.
The research, carried out at the Kilifi Epilepsy and Neurodevelopmental Clinic, analyzed data from 3,016 epilepsy patients who attended the clinic between March 2019 and May 2024.
Epilepsy is a chronic noncommunicable disease of the brain characterized by recurrent seizures, which are brief episodes of involuntary movement. These seizures may affect a part of the body (partial) or the entire body (generalized) and can sometimes be accompanied by loss of consciousness and loss of bowel or bladder control.
Globally, epilepsy affects more than 50 million people, with 80 percent of cases occurring in low- and middle-income countries. Managing the condition effectively remains a challenge, particularly in regions with limited access to newer medications.
The study found that one-third of the patients assessed were on polytherapy due to frequent seizures and focal seizures, which reduce the effectiveness of anti-seizure medications, necessitating the use of multiple drugs.
Children receiving polytherapy were more likely to exhibit behavioral problems, while adults with a longer history of epilepsy had higher incidences of depression and psychosis compared to those on monotherapy. The research used standardized and structured questionnaires, along with the Child Behavior Checklist (CBCL), administered by clinicians.
Five key domains were examined in the study: hypomania, thought insertion, paranoia, strange experiences, and hallucinations. An affirmative response in any of these domains was considered indicative of a mental health issue.
The study highlighted that clinicians often add medications for individuals who continue to experience seizures despite being on one or two anti-seizure drugs. However, findings suggest that epilepsy management with polytherapy may be associated with psychiatric comorbidities.
Some older anti-seizure medications, such as phenytoin, have been linked to psychiatric conditions. Combining such medications may further increase the risk of mental health problems, although the exact mechanisms behind these effects remain unclear and warrant further investigation.
The findings also underscore the challenges of epilepsy management in low-income settings, where access to newer and potentially safer medications like levetiracetam and lamotrigine remains limited.
The risk of premature death in people with epilepsy is up to three times higher than that of the general population. Additionally, three-quarters of people with epilepsy in low-income countries do not receive the treatment they need. Stigma and discrimination against individuals with epilepsy and their families remain widespread in many parts of the world.
The study emphasizes the importance of capacity building among healthcare workers to ensure appropriate medication combinations. There is also a need for investment in newer, safer, and more accessible medications to manage epilepsy while addressing associated mental health issues.
Careful consideration should be given before initiating polytherapy, and mental health problems in individuals with epilepsy should be managed cautiously, as interactions between medications could impact their effectiveness.
