20 - References

References

Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 Epilepsy and driving In the UK, people with epilepsy may not drive a car if they have had a seizure while awake in the previous year. However, they may be eligible to drive if seizures occur only during sleep and this has been an established nocturnal pattern for at least 3 years. The consequences of inducing seizure with antidepressants or antipsychotics can therefore be significant. For further information see https://www.gov.uk/epilepsy-­and-­driving. Other countries have different rules, but most require a seizure-­free period of between 6 and 36 months.71 References

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19. Villanueva V, et al. Proposed recommendations for the management of depression in adults with epilepsy: an expert consensus. Neurol Ther 2023; 12:479–503. Table 10.5  (Continued) Safety in epilepsy Drug Comments Probably low risk64,65 – use with caution (limited data) Amfetamines Data are limited to one small retrospective study in PWE.11 No patients who had well-­controlled epilepsy experienced an increase in seizure frequency.66 Dexamfetamine was historically used as an adjunctive antiseizure agent.67 Atomoxetine Data are limited to one small retrospective study in PWE.11 Discontinuation rates were high (though none due to seizure exacerbation68). Seizure rate similar to placebo for patients without epilepsy.69 Low risk Acetylcholinesterase inhibitors: donepezil/ rivastigmine/ galantamine No increased risk of seizures has been observed.70 This table contains information about the proconvulsive effects of antidepressants and antipsychotics when used in therapeutic doses. See Chapter 13 for information about supratherapeutic doses. EEG, electroencephalogram; MAOIs, monoamine oxidase inhibitors; PWE, people with epilepsy; TCAs, tricyclic antidepressants.

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