Neuropsychiatric Symptoms of Epilepsy

298
M. Beghi et al.
SSRI overdose can cause serotonin syndrome that increases the risk for seizures,
but not all SSRI overdose-induced seizures result from serotonin syndrome.
Inhibition of glycine receptors and hyponatremia can also play a role in SSRI
overdose- induced seizures. Seizures induced by citalopram may occur from QTc
prolongation or inhibition of GIRK channels [ 36 ].
Bupropion
The drug is available in immediate-release (IR), sustained-release (SR), and
extended-release (XL) formulations. The risk for seizures in therapeutic doses
(150–600 mg) is relatively low (0.2 % in prospective studies and 0.4 % in retrospective
studies) [ 30 ]. In randomized clinical trials the prevalence increased to 0.8 % but
half cases had other risk factors [ 30 ]. On the other hand, seizure activity occurred in
21 % of patients with overdose involving the IR formulation, 11 % of patients who
primarily overdosed on the SR formulation, and 32 % of patients who overdosed on
the XL formulation [ 32 ]. Seizures induced by overdose of bupropion are problematic
because they can be repeated and can progress to status epilepticus. Another
problem with bupropion overdose-induced seizures is the delayed onset with which
they can occur. Seizure activity has been reported to occur up to 8 h (mean, 3.7 h),
14 h (mean, 4.3 h), and 24 h (mean, 7.3 h) after overdose on the IR, SR, and XL
preparations, respectively.
Electroconvulsive Therapy
No report of spontaneous seizures was found in a study group of 619 patients.
One patient who was excluded due to suspected neurosyphilis developed recurrent
seizures 1 month after electroconvulsive therapy (ECT). Two patients in the
control group had a single seizure with no relapse. ECT has not been found to
cause epilepsy. Patients’ underlying conditions may influence the development of
seizures [ 38 ].
Antipsychotics
Both first-generation and second-generation antipsychotic medications can increase
the chance of seizures. Hedges and colleagues [ 39 ] reviewed the published literature
concerning the seizure-lowering effects of first- and second- generation antipsychotic
medications, finding that rigorously controlled studies are relatively
infrequent. Of the first-generation antipsychotic medications, chlorpromazine