Selective mutism and obsessive compulsive disorders associated with zonisamide

Abstract

We treated 27 children with idiopathic epilepsy with zonisamide monotherapy over a period of 2 years and observed behaviour disturbances in a prospective study. In all cases, seizure control was excellent; however, two cases (7.4%) had behaviour disturbances. The first (Case 1) was a 14-year-old girl with partial epilepsy which began at age 4 years. Zonisamide was administered at age 6 years, which was effective against her seizures, but selective mutism, violent behaviour, and lack of concentration developed at age 10 years. The second (Case 2) was a 15-year-old girl with generalized tonic-clonic seizures which began at age 10 years. Zonisamide was also effective against her seizures, but obsessive compulsive disorders (OCD) developed at age 13 years. The patients have had no other physical or mental problems and decreasing the dosage of zonisamide reduced the problems. There are few reports of behaviour disturbances provoked by zonisamide monotherapy in epileptic children who are neither physically nor mentally disturbed. While problems can develop several years later, in the present study, decreasing the zonisamide dosage maintained adequate prevention of seizures and eliminated the behaviour disturbances. Zonisamide is still a useful anticonvulsant for epileptic seizures, but physicians should be wary of its adverse behavioural side effects, which may arise several years later.

Clinical Experience With Zonisamide Monotherapy and Adjunctive Therapy in Children With Epilepsy at a Tertiary Care Referral Center

“…43 Similar problematic behaviors in two younger children (ages 1 year and 3 years) were reported in another study from Japan. 43 Similar problematic behaviors in two younger children (ages 1 year and 3 years) were reported in another study from Japan.…”

Psychiatric and Behavioural Disorders in Children with Epilepsy (ILAE Task Force Report): Adverse cognitive and behavioural effects of antiepileptic drugs in children

“…ZNS-induced behaviour disorders were reported in a 1-year-old girl and a 3-year-old boy (Kimura, 1994). Two of the 27 children with idiopathic epilepsy treated with ZNS monotherapy had behaviour disturbances which occurred several years later (Hirai et al, 2002). In one 14-year-old girl, selective mutism, violent behaviour and lack of concentration developed.…”

The Safety and Tolerability of Newer Antiepileptic Drugs in Children and Adolescents

“…[379] However, studies exclusively in children have reported behavioural or psychiatric problems in 4-24%, including agitation, irritability, inattention, hallucinations, hyperactivity, dysphoria, paranoia and psychosis. [368,371,372,380] Mental/psychiatric symptoms were reported in 14-21% of 928 children, [379] and another study reported psychiatric symptoms in 6%. [367] A study of adolescents and adults revealed 19% of 74 patients developed psychosis during zonisamide treatment and that adolescents and young adults are at higher risk.…”