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.
Melani
Federico
F
Department of Neurological and Psychiatric Sciences, 3rd Neurology and Epilepsy Center, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. fedemela@aol.it
Rosati
Eleonora
E
Chiocchetti
Barbara
B
Muscas
Gian Carlo
GC
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