Carbamazepine (CBZ), a widely prescribed AED for both partial and generalized tonic-clonic seizures, has structural properties similar to those of the tricyclic antidepressant imipramine. Absence, myoclonic, and atonic seizures, which may occur commonly among patients with developmental disabilities, do not respond to CBZ and actually may worsen in severity.64,65 Other AEDs with similar spectra of action, such as phenytoin and phenobarbital, may have similar effects on these seizure types. Therefore, although CBZ may be useful for patients with developmental disability, epilepsy, and behavioral disturbances, careful consideration should be given to seizure type.
Few reports cite negative behavioral effects associated with CBZ, although one notable retrospective study of patients with mental retardation who were treated with CBZ for mood disorders found adverse behavioral reactions in nearly 10% of cases.61 For the most part, CBZ-related behavioral problems occur in patients with preexisting behavioral difficulties.62 Other studies have shown behavioral improvement in this population when the drug was removed.10
Numerous reports suggest that CBZ may have utility also in treating impulse control disorders, including borderline personality traits with aggression and dyscontrol syndromes.63 Therefore, on the basis of antimanic and mood-stabilizing properties similar to those described with valproic acid, CBZ may be considered also for use in epilepsy patients who demonstrate both behavioral difficulties and seizures.
Reviewed and revised June 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.
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