Elsevier

Epilepsy & Behavior

Volume 21, Issue 2, June 2011, Pages 173-176
Epilepsy & Behavior

Lamotrigine improves aggression in patients with temporal lobe epilepsy

https://doi.org/10.1016/j.yebeh.2011.03.015Get rights and content

Abstract

Aggression in patients with temporal lobe epilepsy (TLE) may have phenomenological and neurobiological heterogeneity. In the present study, we targeted patients with TLE who showed aggression and evaluated the effects of lamotrigine on this symptom using the Buss–Perry Aggression Questionnaire (BAQ), which is based on a four-factor model that includes Physical Aggression, Verbal Aggression, Anger, and Hostility. As compared with the healthy control subjects (n = 115), patients with TLE (n = 21) had significantly higher BAQ Total, Physical Aggression, Anger, and Hostility scores. Ten weeks after initiation of lamotrigine, the BAQ Total and Anger scores of the patients with TLE were significantly improved. However, the patients with TLE in this study did not exhibit depressive symptoms. Our results suggest that lamotrigine mitigates aggression, especially anger, which represents the emotional factor of aggression in the BAQ.

Research highlights

► The BAQ was used to evaluate aggression in patients with TLE. ► Comparison with 115 healthy subjects, the 21 patients with TLE had higher BAQ scores. ► Lamotrigine improved the patient’s BAQ scores. ► Anger, the affective factor of aggression in the BAQ, was especially improved.

Introduction

Aggression is a personality characteristic and is related to antisocial behavior, though its significance in patients with TLE is a highly controversial issue [1]. According to a previous review [2], patients with TLE are more aggressive than those with other types of epilepsy. However, a problem encountered when studying aggression is its phenomenological and neurobiological heterogeneity, leading to difficulties in assessment and classification [1]. Nevertheless, one line of studies of aggression has consistently recognized at least two subtypes, impulsive and premeditated [1], [3], [4], [5]. Impulsive aggression is typically described as an emotionally charged aggressive response characterized by loss of behavioral control, with behavior that is less structured and defensive [1]. In contrast, premeditated aggression is considered to be displayed in a predatory, goal-directed, and controlled aggressive manner that is usually instrumental in nature [1]. Behavior associated with this type is well structured and purposeful and performed in an emotionally calm state [1]. Stanford et al. suggested that antiepileptic drugs may be applicable to the treatment of impulsive aggression [6]. In recent years, these drugs have become increasing popular for the management of emotional disturbances in patients with psychiatric disorders.

In the present study, we targeted patients with TLE who showed aggression and evaluated the effects of lamotrigine (LTG) on this symptom using the Buss–Perry Aggression Questionnaire (BAQ), a self-rating scale designed for assessing aggression. The BAQ is based on a four-factor model consisting of instrumental, motor, emotional, and cognitive components, which enables phenomenological analysis of aggression in patients with TLE [7], [8], [9].

Lamotrigine is a broad-spectrum antiepileptic drug applicable to partial as well as generalized epilepsy, although it may also have unique psychotropic actions. Many authors have indicated that LTG has antidepressant effects in patients with epilepsy [10], [11], [12], [13], [14], [15]. Furthermore, Labiner et al. suggested that adjunctive LTG improves Anger–Hostility subscale scores of the Profile of Mood States (POMS) significantly more robustly when compared with levetiracetam in patients with partial seizures [16]. Emotional disturbances are major obstacles to improving quality of life in patients with TLE. Therefore, it would be beneficial if LTG could contribute to stabilization of aggression.

Section snippets

Subjects

We enrolled 23 adult patients with TLE (10 males, 13 females), who were diagnosed based on the 1989 International League Against Epilepsy classification. They were either in- or outpatients of the Department of Neuropsychiatry of Aichi Medical University Hospital, and were selected based on the following criteria: (1) seizures that failed to respond to at least one antiepileptic drug and newly given LTG as an adjunct treatment; (2) age ≥ 20 years; (3) no active psychotic state; (4) neither

Comparison of BAQ scores between patients with TLE and control subjects in Table 2

The patient group obtained a significantly a higher Total score as well as higher scores on three subscales—Physical Aggression, Anger, and Hostility—as compared with the control subjects (P = 0.003, 0.025, 0, and 0.008, respectively).

Comparison of patients’ BAQ scores between baseline and endpoint

We also compared the baseline and endpoint BAQ scores of the patients with TLE, as outlined in Table 3. BAQ Total score was significantly improved by the endpoint (P = 0.002). However, of the four BAQ subscales, only the Anger score was significantly improved at the

Discussion

According to a previous review, patients with TLE are more aggressive than those with other types of epilepsy [2]. In general, interictal depression is the most common emotional disturbance seen in patients with TLE, and it frequently accompanies aggressive moods ranging from irritability to explosive anger or rage [18], [19]. Blumer et al. highlighted the characteristic association between interictal depression and anger in patients with epilepsy and designated this dysphoric type of mood

Acknowledgment

The authors express their thanks to Dr. Chiaki Matsudaira for dedicated cooperation.

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