Differential antiseizure medication sensitivity of the Affective Reactivity Index: A randomized controlled trial in new-onset pediatric focal epilepsy

• Type of Material: Article
• Authors: David Loring, Emory University; Kimford Meador, Emory University; Shlomo Shinnar, Albert Einstein College of Medicine; William Daviis Gaillard, Childrens National Health System; James W. Wheless, University of Tennessee; Sudha K. Kessler, University of Pennsylvania; Joan A. Conry, Childrens National Health System; Madison M. Berl, Childrens National Health System; Thomas Burns, Emory University; Tracy A. Glauser, University of Cincinnati; Becky Kinkead, Emory University; Avital Cnaan, George Washington University
• Language: English
• Date: 2020-01-01
• Publisher: Elsevier Science Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.yebeh.2019.106687
• Title of Journal or Parent Work: Epilepsy & Behavior
• Volume: 102
• Start Page: 106687
• End Page: 106687
• Grant/Funding Information: This study was supported by PCORI contract 527.; There was also support at Children's National Hospital site from the Intellectual and Developmental Disabilities Research Center (U54 HD090257).
• Keywords: Behavioral Sciences; Science & Technology; Children; Antiseizure medications; Affective Reactivity Index; Adults; Irritability; Psychiatry; Life Sciences & Biomedicine; Neurosciences & Neurology; Clinical Neurology
• Research Categories: Psychology, Behavioral; Psychology, Psychobiology; Biology, Neuroscience

Abstract

Background: Irritability is a adverse effect of many antiseizure medications (ASMs), but there are no validated measures currently available to characterize this behavioral risk. We examined both child and parent/guardian versions of the Affective Reactivity Index (ARI), a validated measure developed for application in adolescent psychiatry, to determine its sensitivity to ASM-related irritability. We hypothesized irritability increases associated with levetiracetam (LEV) but not lamotrigine (LTG) or oxcarbazepine (OXC). Method: The ARI was administered to 71 child and parent/guardian pairs randomized to one of three common ASMs (LEV, LTG, OXC) used to treat new-onset focal (localization-related) epilepsy. Subjects were recruited as part of a prospective multicenter, randomized, open-label, parallel group design. The ARI was administered at baseline prior to treatment initiation and again at 3 months after ASM initiation. Results: There was a significant increase in ARI ratings for both child and parent/guardian ratings for LEV but not LTG or OXC when assessed 3 months after treatment initiation. When examined on the individual subject level using a criterion of at least a 3-point ARI increase, there was an increase associated with LEV for child ratings but not parent/guardian scores. Conclusion: Both child and parent/guardian versions of the ARI appear sensitive to medication-induced irritability associated with LEV on both the group and individual levels. The findings extend the applicability of ARI from characterizing the presence of clinical irritability as a psychiatric diagnostic feature to a more modifiable aspect of behavior change related to medication management and support its use in clinical trial applications.