CLOZAPINE AND SEIZURES - A REVIEW

Clozapine, a novel antipsychotic agent, is an alternative to standard neuroleptic therapy for psychotic disorders. Some advantages of clozap ine over neuroleptics are that it may be a more effective antipsychoti c in treatment resistant patients and has a lower incidence of extrapy ramidal side effects. However, seizures associated with clozapine trea tment occur at a rate of about three percent. Factors which seem to in crease the likelihood of seizures include high doses of clozapine, rap id dose titration, the concurrent use of other epileptogenic agents an d a previous history of neurological abnormalities. A strategy that ha s been proposed to reduce the occurrence of seizures is the addition o f an anticonvulsant agent. At present, little rigorous scientific evid ence exists to establish the effectiveness of this strategy or the cho ice of an anticonvulsant. However, based on what evidence there is and the side effect profiles of the various anticonvulsants, the authors propose the use of valproic acid for the prophylaxis and management of clozapine related seizures.