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[Use of antiepileptic drugs in schizophrenia: A review of recent evidence].

The treatment of schizophrenia has always been a challenge for clinicians. Neuroleptic monotherapy is not sufficient in all subtypes and all symptoms of schizophrenia. New treatment strategies have been developed including the combination of neuroleptics and antiepileptics. We summarize papers published on the efficacy and the action mechanism of antiepileptic agents in schizophrenia. We have searched the computer database system MEDLINE and COCHRANE for relevant articles. GABA and glutamate are involved in the symptom improvement of schizophrenia when antiepileptics are added in the main neuroleptic treatment. Augmentation treatment with valproate leads to a decrease in hostility, violent behavior, agitation and anxiety and is related to fewer days of hospitalization. Carbamazepine has been used as a calmative and is effective in controlling patients with psychomotor agitation. Whether both antiepileptics can reduce positive and negative symptoms in schizophrenia, still remains controversial. Oxcarbazepine has a very safe pharmaceutical profile in combination with neuroleptics but only a single study indicates its efficacy. Adjunctive lamotrigine appears effective when added to clozapine even in cases of treatment resistant schizophrenia. Both lamotrigine and clozapine share anti-glutamatergic actions. There have been reported few studies which support the use of topiramate in schizophrenia. Future studies on a great number of patients will provide more reliable evidence. Finally the potential role of new antiepileptics has to be evaluated using new clinical testing.