Antidepressant-associated myoclonic status in a patient with symptomatic generalized epilepsy: does risk occur with therapeutic doses?
The clinical and EEG data of a 49-year-old man with myoclonic and generalized tonic-clonic seizures resulting from early childhood encephalitis are described. He experienced no tonic-clonic seizure for 10 years before brief exposure first to 60 mg/day duloxetine and then to 20mg/day paroxetine for depressive symptoms. These drugs were separately prescribed at a 9-month interval, and after beginning each drug, the patient experienced tonic-clonic seizures of worsening intensity and myoclonus of increasing frequency. Clinical features correlated with subcontinuous, generalized spike-wave discharges on the EEG. Discontinuation of antidepressant treatment resulted in rapid disappearance of clinical and electrophysiological manifestations of myoclonic status. We suggest care must be taken when using serotonin-noradrenaline reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs), as these drugs pose the risk of complications in the specific population of people with myoclonic seizures.
Department of Neurological and Psychiatric Sciences, 3rd Neurology and Epilepsy Center, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. fedemela@aol.it
Federico
F
Melani
Eleonora
E
Rosati
Barbara
B
Chiocchetti
Gian Carlo
GC
Muscas
D000928:Antidepressive Agents / Q000009:adverse effects*; D003863:Depression / Q000188:drug therapy / Q000209:etiology; D000068736:Duloxetine Hydrochloride; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000009:adverse effects*; D012640:Seizures / Q000150:complications / Q000188:drug therapy; D013876:Thiophenes / Q000009:adverse effects*
D000928:Antidepressive Agents; D013876:Thiophenes; D017374:Paroxetine; D000068736:Duloxetine Hydrochloride