Abstracts

Studies on the risk of increased seizures secondary to antidepressants in people with epilepsy are scarce; especially in children. According to Schmitz (2002), risk of antidepressants provoking seizures is probably overestimated. In adults, selective serotonin reuptake inhibitors (SSRI) have shown a lower risk compared with tricyclic antidepressants (Kanner et al.2000). We aimed to analyze SSRI in children and adolescents with epilepsy and depression as to efficacy, adverse effects and effect on epileptic seizures. The multidisciplinary team of the Unit for Research and Diagnostic of Epilepsy and Psychiatric Disorders in Childhood of the University of Sao Paulo studied all patients with a standard questionnaire. Epileptic seizures and syndromes were classified according to ILAE guidelines (1981; 1989) by history, file revision and V-EEG, when necessary. Patients were evaluated by a child psychiatrist with a structured anamnesis and classified according to DSM IV, CID 10 and KIDDIE-SADS. We prospectively assessed the seizure frequency of consecutive children with depression and epilepsy treated with SSRI. We compared the monthly seizure frequency recorded with a calendar (6-12 months after SSRI) with those registered 6 -12 months preceding the start of SSRI (baseline). Our group was made up by 69 patients (37 boys [53.6%]). Thirteen patients (18.8%) were under [lt] 6 years, 27(39.1%) from 7 to 13, and 29 (42.1%) over 13 years. As to diagnosis of epilepsy, 55 children (79.7%) had partial epilepsy; 42 had symptomatic epilepsy (60.9%), 21 (30.4%) cryptogenic and 7 (10.1%) idiopathic. Twenty-five patients (36.23%) had diagnosis of depressive disorder and were treated with SSRI. Out of these, 16 were treated with sertraline and 9 with fluoxetine, with the following adverse effects: one (4%) had facial flushing with fluoxetine and one (4%) presented diarrhea with sertraline. Two (8%) had seizure worsening with sertraline. In three patients with adverse-effects, change of SSRI in use for another was warranted. Only one patient with seizure aggravation did not tolerate SSRI at all and parents did not allow AED increase.Therefore, 23/25 patients (92%) presented satisfactory therapeutic response with SSRI, without seizure worsening. Although SSRI are considered as drugs of low epileptogenicity there are up to date no studies in children. In this series we were able to observe that SSRI may be a good therapeutic choice for children with epilepsy and depression, with excellent efficacy, few adverse effects, and maintenance of satisfactory seizure-control.