Priority 9 from the Epilepsy (Canada) PSP

UNCERTAINTY: Aside from anti-seizure drugs and some brain lesions, what causes behavioural changes in people who experience seizures? What is the best way to treat behavioural issues? (JLA PSP Priority 9)
Overall ranking	9
JLA question ID	0110/9
Explanatory note	Behavioural changes, such as depression, anxiety, impulsiveness, aggression, and attentional difficulties are often seen in people with epilepsy. Some of these changes may be due to side effects of anti-seizure drugs (ASDs), some may be caused by structural abnormalities in the brain, and some may be caused by seizures themselves. In addition, there may be other contributing factors, such as stress, environment, sleep quality or social settings. More research is needed to determine how each of these affect cognition and behaviour. Current treatments include counselling or psychotherapy, modifying or changing ASDs, or adding medication to treat behavioural issues. Researchers are still trying to determine the most effective treatments or therapies to manage behavioural changes in people with epilepsy. Another key question is how to effectively treat seizures while minimizing or managing behavioural changes.
Evidence	Ayuga Loro, F., Gisbert Tijeras, E., & Brigo, F. (2020). Rapid versus slow withdrawal of antiepileptic drugs. Cochrane Database of Systematic Reviews(1). doi:10.1002/14651858.CD005003.pub3 Nevitt, S. J., Tudur Smith, C., & Marson, A. G. (2019). Phenobarbitone versus phenytoin monotherapy for epilepsy: an individual participant data review. Cochrane Database of Systematic Reviews(7). doi:10.1002/14651858.CD002217.pub3 Geng, J., Dong, J., Li, Y., Ni, H., Jiang, K., Shi, L. L., & Wang, G. (2019). Intravenous immunoglobulins for epilepsy. Cochrane Database of Systematic Reviews(12). doi:10.1002/14651858.CD008557.pub4 Brigo, F., Igwe, S. C., & Lattanzi, S. (2019). Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents. Cochrane Database of Systematic Reviews(2). doi:10.1002/14651858.CD003032.pub4 Brigo, F., Igwe, S. C., Bragazzi, N. L., & Lattanzi, S. (2019). Clonazepam monotherapy for treating people with newly diagnosed epilepsy. Cochrane Database of Systematic Reviews(11). doi:10.1002/14651858.CD013028.pub2 Tatum, W. O., Rubboli, G., Kaplan, P. W., Mirsatari, S. M., Radhakrishnan, K., Gloss, D., . . . Beniczky, S. (2018). Clinical utility of EEG in diagnosing and monitoring epilepsy in adults. Clinical Neurophysiology, 129, 1056-1082. doi:10.1016/j.clinph.2018.01.019 Nevitt, S. J., Marson, A. G., & Tudur Smith, C. (2018). Carbamazepine versus phenobarbitone monotherapy for epilepsy: an individual participant data review. Cochrane Database of Systematic Reviews(10). doi:10.1002/14651858.CD001904.pub4 See the PSP datasheet to see the full list of evidence identified
Health Research Classification System category	Neurological

Extra information provided by this PSP
Original uncertainty examples	Behavioural issues: Why is there such a high rate in epilepsy? Differentiate between behaviour and seizures? ~ Are my child's behavioural issues part of a larger syndrome that relates to the epilepsy? -Will my child ever develop enough to 'catch up' to peers in terms of abilities? ~ Can epilepsy cause behavioural changes, depression, or increased anxiety? Can epilepsy affect learning capabilities? ~ What is the latest evidence about the treatment strategies of depression, anxiety, and behavioural problems for people with epilepsy?
Submitted by	People with Seizures x 6, Caregivers x 1, Friend or Family Member x 10, Health Care provider x 2, Community Agency Representative x 1

Extra information provided by this PSP

Original uncertainty examples

Behavioural issues: Why is there such a high rate in epilepsy? Differentiate between behaviour and seizures? ~ Are my child's behavioural issues part of a larger syndrome that relates to the epilepsy? -Will my child ever develop enough to 'catch up' to peers in terms of abilities? ~ Can epilepsy cause behavioural changes, depression, or increased anxiety? Can epilepsy affect learning capabilities? ~ What is the latest evidence about the treatment strategies of depression, anxiety, and behavioural problems for people with epilepsy?

Submitted by

People with Seizures x 6, Caregivers x 1, Friend or Family Member x 10, Health Care provider x 2, Community Agency Representative x 1

PSP information
PSP unique ID	0110
PSP name	Epilepsy (Canada)
Total number of uncertainties identified by this PSP.	96 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	6th & 7th April 2021