Abstracts

Rationale: Patients with epilepsy (PWE) often experience concurrent psychiatric disorders such as depression (20-55%), anxiety (12-22%), and suicidality (25%), necessitating the use of psychotropic medications ¹. The prevalence of attention-deficit/hyperactivity disorder (ADHD) is also high among PWE, ranging from 12% to 70% depending on epilepsy severity and age group ¹. Psychiatric comorbidities complicate epilepsy management and potentially lower the seizure threshold, establishing a bidirectional relationship between epilepsy and psychiatric conditions ¹. This study aims to assess the seizure risk associated with various classes of psychotropic drugs in PWE to inform safer treatment strategies.


Methods: A comprehensive literature review was conducted to synthesize empirical evidence on the risk of iatrogenic seizures associated with antidepressants, CNS stimulants, and antipsychotics ^1,2,3,4. Data from multicenter randomized controlled trials, population-based studies, and case reports were analyzed to determine the incidence of seizures with these medications ³. Standardized incidence ratios (SIR) and hazard ratios (HR) were calculated to compare seizure risks between psychotropic drugs and placebos ^1,2.


Results: Antidepressants, particularly tricyclics and bupropion IR, showed increased seizure risk, with SIRs of 1.58 and 4.08, respectively ². However, SSRIs and SNRIs had a lower seizure incidence compared to placebos (SIR = 0.48) ². CNS stimulants like methylphenidate demonstrated effectiveness without increasing seizure risk, while atomoxetine had a low seizure incidence comparable to placebos ³. First-generation antipsychotics, especially clozapine, and high-dose chlorpromazine were associated with higher seizure risks, while second-generation antipsychotics like olanzapine and quetiapine showed variable but generally lower risks ¹.


Conclusions: Understanding the seizure risks associated with psychotropic medications is critical for optimizing treatment in PWE. Antidepressants and antipsychotics, particularly specific drugs like clomipramine and clozapine, require careful monitoring due to their higher seizure risks. SSRIs, SNRIs, and certain CNS stimulants present safer options. This review emphasizes the need for tailored psychotropic therapy to minimize seizure risk while effectively managing psychiatric comorbidities in PWE, thus improving overall patient outcomes. No funding was received for this study.


Funding: No funding.