LA PRESCRIPTION DE LA RISPERIDONE CHEZ LES ENFANTS ET LES ADOLESCENTS EPILEPTIQUES

Objectives: This study aims to analyze the clinical characteristics and prescribing patterns of risperidone in children and adolescents with epilepsy, assess its tolerance and effectiveness, and reflect on best prescribing practices in this specific population.

Patients and Method: We conducted a retrospective, descriptive study over one year (January 2022-January 2023) involving children and adolescents aged 2 to 16 years diagnosed with epilepsy and psychiatric comorbidities, and treated with risperidone.

Results: We included 86 patients referred to a university child psychiatry unit. Psychiatric comorbidities were found in 72.06% of cases, mainly intellectual disability (45.34%) and autism spectrum disorder (19.76%). Multidisciplinary management-including psychoeducation, parental guidance, and psychomotor or speech therapy-was applied in nearly 70% of patients. Risperidone was prescribed in 14 cases for severe behavioral disturbances, primarily in the context of comorbid intellectual disability or autism. The average dose was 1 mg/day for 4 to 6 weeks. A standard pre-treatment work-up was performed, and no adjustments to antiepileptic therapy were needed. All patients showed behavioral improvement, including better sleep, with no seizure worsening or reported side effects. Treatment was closely monitored in collaboration with pediatric neurologists.

Discussion: The use of psychotropics in children and adolescents with epilepsy should be part of a multimodal developmental approach. Although off-label in this population, antipsychotics may be appropriate when behavioral disturbances significantly impair functioning and non-pharmacological strategies are insufficient. Risperidone, the most studied antipsychotic in pediatrics, is widely used in neurodevelopmental disorders. In our cohort, it demonstrated effectiveness, tolerability, and safety with no seizure exacerbation during short-term follow-up.

Conclusion: Risperidone appears to be an effective and well-tolerated option for managing severe behavioral issues in children and adolescents with epilepsy, particularly when psychiatric comorbidities hinder developmental progress.