USE OF CLOZAPINE FOR PSYCHIATRIC COMPLICA TIONS OF PARKINSONS-DISEASE

Background: Medical treatment of Parkinsonian syndromes is often compl icated by psychiatric side effects such as confusional states, halluci nations and psychosis. Recent pilot studies report good clinical resul ts with the atypical neuroleptic clozapine. Patients and Methods: We r eport on 15 patients with Parkinsonian syndromes: 11 with idiopathic P arkinson's disease (IPD), 3 with multiple system atrophy (MSA) and 1 w ith postencephalitic Parkinsonism (SPP). The mean age was 68.8+/-10 ye ars, the mean duration of Parkinsonian symptoms was 6.81+/-7 years. Th e Hoehn & Yahr grade was: 3.5+/-0.8. Eleven patients were suffering fr om psychotic episodes, 10 from hallucinations, 8 from confusional stal es. Clozapine was introduced at nighttime and dosage was modified unti l the appearance of clinical effect or intolerable side effects. Resul ts: We report on an observed cumulative duration of clozapine treatmen t of 13 patient-year. The average treatment duration was 10.5+/-10.4 m onths. The mean daily dose was 33.3+/-30 mg (range: 6.2-100). There wa s al (east transitory improvement of psychiatric symptoms in all patie nts. There was constant and complete improvement in 7 patients (46%) a nd satisfactory inprovement in 5 patients (33.3%). The levodopa dosage was uncharged (mean dosage 563+/-232 mg), and the dosage of dopamine agonists was significantly increased. None of our patients experienced motor deterioration. Side effects comprised sialorrhoea, sedation, or thostatic hypotension, and delirium tremens and an epileptic seizure i n one patient each. Two patients died suddenly at the 63rd and at the 86th day of treatment respectively outside the hospital. These deaths seemed to be unrelated to the treatment. There was no agraniliocytosis . Conclusion: Clozapine is an efficient antipsychotic drug in Parkinso nia patients with no motor side effects in the dosages used. The effec tive dosage is very low in comparison to psychiatric patients. However various side effects may occur and close, monitoring is required.