Epilepsia, 51(10):2211–2214, 2010 doi: 10.1111/j.1528-1167.2010.02594.x
BRIEF COMMUNICATION
Serotonin reuptake inhibitors are associated with reduced severity of ictal hypoxemia in medically refractory partial epilepsy *Lisa M. Bateman, yChin-Shang Li, zTzu-Chun Lin, and *Masud Seyal Departments of *Neurology, yPublic Health Sciences, Division of Biostatistics, and zStatistics, University of California, Davis, California, U.S.A.
SUMMARY Ictal respiratory dysfunction occurs in patients with epilepsy and may contribute to sudden unexplained death in epilepsy (SUDEP). Fluoxetine reverses respiratory arrest in a mouse model of epilepsy, suggesting that selective serotonin reuptake inhibitors (SSRIs) may reduce ictal respiratory dysfunction. Video–electroencephalography (EEG) and pulse oximetry data from 496 seizures in 73 consecutive patients with partial epilepsy was reviewed, including 87 seizures in 16 patients taking SSRIs (SSRI+)
Sudden unexplained death in epilepsy (SUDEP) is a common cause of death in patients with epilepsy (TellezZenteno et al., 2005), and seizure-associated cardiac and respiratory dysfunction are implicated (So et al., 2000). We have demonstrated a high incidence of respiratory dysfunction in patients with localization-related epilepsy that may be severe and likely to recur (Bateman et al., 2008; Seyal et al., 2010). A sheep model of bicuculline-induced epileptic sudden death suggests that ictal hypoventilation contributes to SUDEP (Johnston et al., 1997). Patients with intractable localization-related epilepsy may not be candidates for epilepsy surgery, or surgery may be delayed. Therefore, interventions to limit ictal hypoxemia should be evaluated. Serotonin and other neurotransmitters influence brainstem respiratory center excitability, and serotonergic changes have been reported in sudden infant death syndrome, a condition with similarities to SUDEP (Kinney et al., 2009). Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), reverses respiratory arrest in a mouse model of epilepsy (Tupal & Faingold, 2006).
Accepted March 16, 2010; Early View publication May 14, 2010. Address correspondence to Masud Seyal MD, PhD, Department of Neurology, Clinical Neurophysiology, UCDMC, 2315 Stockton Boulevard, Room 5308, Sacramento, CA 95817, U.S.A. E-mail:
[email protected] Wiley Periodicals, Inc. ª 2010 International League Against Epilepsy
and 409 seizures in 57 patients not taking SSRIs (SSRI)). The proportion of ictal-related oxygen desaturation
