The Effect of Selective Serotonin Reuptake Inhibitors on the Frequency of Psychogenic Nonepileptic Seizures A Critically Appraised Topic

Departments of *Neurology †Library Services, Division of Education Administration ‡Department of Psychiatry, Mayo Clinic, Scottsdale, AZ and Phoenix, AZ.
The Neurologist (Impact Factor: 1.16). 01/2013; 19(1):30-3. DOI: 10.1097/NRL.0b013e31827c6bfd
Source: PubMed


: Psychogenic nonepileptic seizures (PNES) are commonly encountered problem in neurological practice and usually are accompanied by other psychiatric comorbidities. Despite its prevalence and profound impact on patients and families, there have been few trials addressing treatment. Cognitive behavioral therapy may be effective but the role of pharmacologic therapy remains unclear.
: To critically evaluate evidence that PNES frequency may be reduced by treatment with selective serotonin reuptake inhibitors.
: The objective was addressed through the development of a structured, critically appraised topic. We incorporated a clinical scenario, background information, a structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, epileptology, and psychiatry content experts.
: A pilot randomized control clinical trial was selected for critical appraisal. Thirty-eight PNES patients were randomized to flexible-dose sertraline (target dose, 200 mg/d) or placebo. Only 68% of patients contributed data to the primary analysis and baseline PNES frequency was notably dissimilar. Twelve-week seizure frequency rates, as compared with baseline, were 45% lower in the sertraline group (P=0.03) but unchanged in the placebo group (8% increase; P=0.78). After adjustment for baseline differences, between-treatment group comparison revealed a trend toward lower event frequency in the sertraline group (risk ratio 0.51; 95% confidence interval, 0.25-1.05; P=0.29). Psychosocial and quality of life measures did not differ between treatment groups.
: There is insufficient evidence to recommend routine treatment with sertraline to reduce PNES event frequency but these pilot data suggest a possible benefit worthy of further exploration.

1 Follower
23 Reads

  • No preview · Article · Jul 2013 · Annals of Indian Academy of Neurology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Depression is a state of low mood and aversion to activity. It may occur due to existence of other mental or physical diseases or from the medications for those illnesses. It is one of the leading sources of disability. Among these physical diseases, epilepsy is widely recognized as one of the main causes of depression. Patients with epilepsy are at high risk of developing depressive symptoms, and the suicide rates in patients with epilepsy have been reported to be much higher than in the general population. However, due to fears of lowering seizure threshold and adverse drug interactions between antidepressants and antiepileptic drugs, physician are reluctant to place patients with epilepsy on antidepressant medication. As a result, the question has been raised that what the best managements should be used to treat epileptic patients with depression. In this review, the currently used medications for antidepressants and antiepileptic drugs were summarized by their working targets in order to establish appropriate pharmacological management of depression and epilepsy. Despite the complex relationship between epilepsy and depression, coadministration of antidepressants and AEDs can still be done safely and effectively under the conditions of good clinical management. The ideal antidepressants for people with epilepsy should be efficacious but with few adverse effects, which will not antagonize GABAergic mechanisms or interfere with plasma anticonvulsant concentrations.
    No preview · Article · Oct 2014 · International Journal of Neuroscience