Can buspirone shorten the seizure duration in connection to electro-convulsive therapy?/nA 73-year-

Fråga: Can buspirone shorten the seizure duration in connection to electro-convulsive therapy?

A 73-year-old woman is treated with electro-convulsive therapy due to a depression. Since treatment with buspirone was added, the duration of the grand mal seizures has become shorter.

Sammanfattning: Paradoxically, buspirone has been reported to suppress myoclonus and produce myoclonus. The mechanism of action is unclear. In this patient the shorter duration of grand mal seizures in electro-convulsive therapy cannot be excluded to be caused by buspirone.

Svar: A thorough literature search including Drugline, Medline and common pharmacological handbooks has been performed. Buspirone is a serotonin 5-HT1A agonist that is not chemically or pharmacologically related to the bensodiazepines. The substance is used in treatment of anxiety (1).

We found only one case report concerning a 76-year-old man who developed bilateral myoclonus and confusion two days after an uncomplicated surgery of an inguinal hernia. Treatment with buspirone was chosen since the symptoms worsened during a trial with carbamazepine. With buspirone 5 mg three times daily the symptoms resolved. The author suggested that the effect of buspirone may be due to its major metabolite 1,2-pyrimindyl-piperazine, that mimics bensodiazepine at some sites in the complex bensodiazepine-GABA receptors (2).

However, in literature there are also reports on buspirone therapy alone or in combined regimens with eg antidepressants as a cause to myoclonus (3,4). One case of seizures in connection to buspirone treatment has previously been reported to SADRAC (The Swedish Adverse Reactions Advisory Committee).

We recommend this case be reported to SADRAC. 1 FASS 1997 (The Swedish Catalog of Approved Medical Products) 2 Greenberg DB: Buspirone for myoclonus, obsessive fears, and confusion. Psychosomatics 1993; 34: 270-272 3 Pranzatelli MR, Franz D, Tate E, Martens JM: Buspirone in progressive myoclonus epilepsy. J Neurol Neurosurg Psychiatry 1993; 56: 114-115 4 Grady TA, Pigott TA, L´Heureux F, Murphy DL: Seizure associated with fluoxetine and adjuvant buspirone therapy. J Clin Psychopharmacol 1992; 12: 70-71