Abstracts

Depression is more common among patients with epilepsy than it is in the general population. Bupropion hydrochloride, is an effective adjunctive and first line antidepressant. Its use is not associated with most of the side effects that limit the usefulness of selective serotonin re-uptake inhibitors. Moreover, it can be helpful in smoking cessation and painful neuropathies. However, it can cause seizures in patients without risk factors for epilepsy. The sustained release preparation appears less likely to cause seizures but is still contraindicated in patients with a seizure disorder. Nevertheless some patients who have seizures while taking bupropion appear to do well when switched to the sustained release preparation and some patients with epilepsy treated with anticonvulsants appear to tolerate bupropion without an exacerbation of their seizures. We attempted to find clinical evidence to support the prohibition of sustained release bupropion in patients with epilepsy.
We reviewed the records of all patients with epilepsy treated by us over the past five years and identified 28 (six with idiopathic primary generalized epilepsy and 22 with localization related epilepsy) who had used sustained release bupropion in divided doses. We reviewed the patient[rsquo]s charts and when necessary spoke with the patients by phone.
One patient with 38 years of uncontrolled myoclonic and absence seizures reported that a single 100 mg tablet increased the frequency of her myoclonus. The five other patients with generalized epilepsy whose seizures were all easily controlled (three with juvenile myoclonic epilepsy, one with awakening grand mal and one with absence and grand mal) have remained seizure free for two months to two years on 150 mg b.i.d. Two patients with intractable weekly partial seizures tried the drug to stop smoking. For one it worked without incident the first time but the following year at the same 300 mg dose she had more simple partial seizures. The other patient tried it three times; the second time she had more complex partial seizures. Another patient with intractable weekly seizures due to an oligodendroglioma reported more [ldquo]warnings[rdquo] but no seizures. The remaining 19 patients including 11 with uncontrolled partial seizures and two with tumors reported that bupropion (200 mg in three and 300 mg in 16) had no effect on their seizures when taken for periods of two weeks to two years.
In this small group of patients with epilepsy, more than half of whom had uncontrolled seizures, sustained release bupropion given in divided doses not to exceed 300 mg per day caused no convulsive seizures and an increase in seizures associated with impairment of consciousness in only one patient (and then only on one of the three times she tried it). Depression and tobacco addiction are serious conditions. When they coexist with epilepsy the use of bupropion may be a reasonable consideration..