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Effects of psychotropic drugs on
seizure threshold.
Pisani F, Oteri G, Costa C, Di
Raimondo G, Di Perri R.
Department of Neurosciences and of
Psychiatric and Anaesthesiological Sciences, First Neurological Clinic,
The University of Messina, Messina, Italy.
pisanif@www.unime.it
Psychotropic drugs, especially
antidepressants and antipsychotics, may give rise to some concern in
clinical practice because of their known ability to reduce seizure
threshold and to provoke epileptic seizures. Although the phenomenon has
been described with almost all the available compounds, neither its real
magnitude nor the seizurogenic potential of individual drugs have been
clearly established so far. In large investigations, seizure incidence
rates have been reported to range from approximately 0.1 to
approximately 1.5% in patients treated with therapeutic doses of most
commonly used antidepressants and antipsychotics (incidence of the first
unprovoked seizure in the general population is 0.07 to 0.09%). In
patients who have taken an overdose, the seizure risk rises markedly,
achieving values of approximately 4 to approximately 30%. This large
variability, probably due to methodological differences among studies,
makes data confusing and difficult to interpret. Agreement, however,
converges on the following: seizures triggered by psychotropic drugs are
a dose-dependent adverse effect; maprotiline and clomipramine among
antidepressants and chlorpromazine and clozapine among antipsychotics
that have a relatively high seizurogenic potential; phenelzine,
tranylcypromine, fluoxetine, paroxetine, sertraline, venlafaxine and
trazodone among antidepressants and fluphenazine, haloperidol, pimozide
and risperidone among antipsychotics that exhibit a relatively low risk.
Apart from drug-related factors, seizure precipitation during
psychotropic drug medication is greatly influenced by the individual's
inherited seizure threshold and, particularly, by the presence of
seizurogenic conditions (such as history of epilepsy, brain damage,
etc.). Pending identification of compounds with less or no effect on
seizure threshold and formulation of definite therapeutic guidelines
especially for patients at risk for seizures, the problem may be
minimised through careful evaluation of the possible presence of
seizurogenic conditions and simplification of the therapeutic scheme
(low starting doses/slow dose escalation, maintenance of the minimal
effective dose, avoidance of complex drug combinations, etc.). Although
there is sufficient evidence that psychotropic drugs may lower seizure
threshold, published literature data have also suggested that an
appropriate psychotropic therapy may not only improve the mental state
in patients with epilepsy, but also exert antiepileptic effects through
a specific action. Further scientific research is warranted to clarify
all aspects characterising the complex link between seizure threshold
and psychotropic drugs.
Publication Types:
PMID: 11888352 [PubMed - indexed for
MEDLINE]
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