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| |  SSRIs May Prolong Seizure Duration but Shorten Post-Seizure Depression in Patients With Epilepsy: Presented at AES By John Otrompke BOSTON -- December 6, 2009 -- Use of selective serotonin reuptake inhibitors (SSRIs) appears to be associated with longer seizures in patients with epilepsy, confounding basic science results suggesting SSRIs reduce the frequency of epileptic seizures in animal models, according to a study presented here at the American Epilepsy Society (AES) 63rd Annual Meeting. “What we found was not necessarily a causal relationship, but an association, between SSRI use and longer seizures,” study presenter Eugen Trinka, MD, MSc, Innsbruck Medical University, Innsbruck, Austria. “Based on our study, we cannot conclude that SSRIs prolong seizures.” However, “doctors should use caution in using SSRIs in patients with epilepsy,” Dr. Trinka added during his poster presentation held on December 5. The study found that epilepsy seizures in those on SSRIs lasted a median 132 seconds, compared with 85 seconds in those not using SSRIs. Researchers conducted a nested study of 162 patients with focal epilepsies admitted for video-electroencephalogram (EEG) monitoring between 2006 and 2008. Of those, they identified 11 patients treated with SSRIs who had 16 grand mal seizures and 19 focal complex seizures, and compared them with 13 control patients who were not treated with SSRIs, but had the same type of seizures. The seizures were matched chronologically in order of their appearance during monitoring sessions; they were also matched according to sex, age, aetiology, and type of recording. “On the other side, there is basic science evidence that SSRIs decrease seizure activity and are anti-epileptic, including quite strong experimental animal data,” noted Dr. Trinka. Fluoxetine had previously been found to protect mice from sudden unexpected death in epilepsy patients (SUDEP). The study also found no significant difference in the duration of postictal EEG depression between the 2 groups: The period lasted a median of 214.5 seconds for those on SSRIs, compared with 219.5 seconds for those not on SSRIs. Therefore, the finding should be used cautiously, said Dr. Trinka. “Maybe some patients on SSRIs have depression because they have more severe epilepsy, which is associated with longer seizures,” he speculated. “We probably have to look more closely at postictal depression,” Dr. Trinka said. The postictal period is characterised by a comatose state or deep sleep, in which the patient sometimes stops breathing and dies. “If we find that SSRIs go with longer seizures, but shorter postictal depression, one might argue that SSRIs are protective,” he said. [Presentation title: SSRIs Prolong Seizure Duration in Patients With Focal Epilepsies. Abstract 1.115]
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