SSRIs, TCAs, Antipsychotics Decrease Seizure Frequency in the Epilepsy Monitoring Unit

epilepsy, seizures, seizure, EEG
epilepsy, seizures, seizure, EEG
Patients taking an active treatment regimen consisting of SSRIs, TCAs, or antipsychotic medications are less likely to experience a seizure in the epilepsy monitoring unit.
The following article is part of conference coverage from the American Epilepsy Society’s Annual Meeting in New Orleans, LA. The Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AES 2018.

Patients taking an active treatment regimen consisting of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), or antipsychotic medications are less likely to experience a seizure in the epilepsy monitoring unit, according to research data presented at the 2018 American Epilepsy Society meeting held November 30-December 4 in New Orleans, Louisiana.

“Traditionally, antiepileptic drugs are tapered or discontinued in the epilepsy monitoring unit,” the investigators reported. “Around 20 to 50% of patients with epilepsy have psychiatric comorbidities, and generally home psychotropic drugs are continued in these patients. There is sparse data on how psychotropic drugs impact seizure frequency in [patients in the epilepsy monitoring unit].”

The researchers reviewed the data from a total of 682 patients who were admitted to a single epilepsy monitoring unit for >1 day for seizure evaluation. Patients taking either SSRIs (n=178), TCAs (n=35), serotonin norepinephrine reuptake inhibitors (SNRIs) (n=43), and/or antipsychotic medications (n= 45) were compared with patients not taking these medications (n=637) with regard to seizure frequency.

Patients who were not taking SSRI drugs during their stay in an epilepsy monitoring unit had a 1.6 times greater likelihood of experiencing a seizure compared with patients treated with SSRIs (incidence risk ratio [IRR], 1.64; 95% CI, 1.21-2.24; P =.002).

There was a 2.4 times greater likelihood for seizures in patients not receiving antipsychotic drugs vs patients taking the medications (IRR, 2.41; 95% CI, 1.23-4.73; P =.011). Treatment with TCA drugs was associated with no incidence of seizures. Patients treated with SNRIs, however, had a 1.9 times greater likelihood of having a seizure during monitoring compared with patients not receiving SNRIs (IRR, 1.85; 95% CI, 1.19-2.86; P =.006).

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“Although the mechanism is unknown, [these findings] could have implications on the length of stay and may potentially affect decisions regarding medication management in the [epilepsy monitoring unit],” the researchers concluded.

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Kolikonda M, Yeruva R, Unroe B, Ziegler C, Bilal M, Chapman B. Do psychotropic drugs impact seizure frequency in epilepsy monitoring unit patients? Presented at: 2018 American Epilepsy Society meeting; November 29-December 4, 2018; New Orleans, Louisiana. Abstract 3.264.