Our report concerns 2 patients who developed delirium after an epileptic attack during mianserin treatment. In both cases the EEG showed a change with periodic sharp slow complexes similar to that seen in Creutzfeldt-Jakob disease. The symptoms subsided, however, and the EEG normalized after the antidepressant was discontinued, suggesting a noxious response to mianserin. If Creutzfeldt-Jakob-like changes in the EEG occur, the possible effect of antidepressant medication should be considered.

Tricyclic and newer antidepressants have certain undesirable effects, including an increased susceptibility to delirium, myoclonic jerks, and epileptic convulsions.'Two patients had an epileptic attack during mianserin treatment followed by delirium and EEG changes presenting as slow activity with periodic complexes similar to those seen in the Creutzfeldt-Jakob disease.A 61 year old male had suffered from paranoid schizophrenia since 1955. The patient was admitted to hospital due to increased psychotic symptoms in August 1987. On admission, medication previously used (promazine 200 mg and mianserin 60 mg in the evening) were continued and chlorpromazine 100 mg, three times a day, was introduced. He developed acute leftsided hemiplegia five days after admission. CT of the head showed central atrophy and a new right parietal infarction. Five days after the stroke the temporarily discontinued neuroleptic and antidepressant medications were reintroduced due to nocturnal delirium and a continuation of psychotic symptoms during the daytime. Two weeks later he had numerous grand mal attacks associated with periodic slow complexes similar to that seen in Creutzfeldt-Jakob disease (CJD) on EEG.Both symptoms subsided after the introduction of carbamazepine and discontinuation of mianserin. The patient recovered from the hemiplegia and delirium, and during a follow up In some areas the clinical emphasis will seem strange to a British readership. For example, two pages are devoted to spinal cord tumours, 27 to examination of the testes and a similar number to temporo-mandibular joint dysfunction.As a neuro-MR reference work this adds little to the much smaller "MRI of the CNS" by M. Brant