A Comparison of the Effects of Clozapine and Olanzapine on the EEG in Patients with Schizophrenia

Schuld, Andreas; Kuhn, Matyáš; Haack, Monika; Kraus, Thomas; Hinze-Selch, D.; Lechner, Corinna; Pollmächer, Thomas

doi:10.1055/s-2000-7976

Cited by 39 publications

(7 citation statements)

References 8 publications

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“…It was also observed that EEG abnormalities were statistically significantly increased with dose in the olanzapine group [7]. In another study, a proportion of 44% of patients with EEG abnormalities under olanzapine treatment was described; however, this was based on a small sample size ( n = 9 in [15]). The proportion of EEG abnormalities in a study by Centorrino et al [6] was also comparable (38.5%).…”

Section: Discussionmentioning

confidence: 99%

EEG alterations during treatment with olanzapine

Degner

Nitsche

Bias

et al. 2011

Eur Arch Psychiatry Clin Neurosci

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The aim of this naturalistic observational study was to investigate EEG alterations in patients under olanzapine treatment with a special regard to olanzapine dose and plasma concentration. Twenty-two in-patients of a psychiatric university ward with the monodiagnosis of paranoid schizophrenia (ICD-10: F20.0), who received a monotherapy of olanzapine were included in this study. All patients had a normal alpha-EEG before drug therapy, and did not suffer from brain-organic dysfunctions, as verified by clinical examination and cMRI scans. EEG and olanzapine plasma levels were determined under steady-state conditions (between 18 and 22 days after begin of treatment). In 9 patients (40.9%), pathological EEG changes (one with spike-waves) consecutive to olanzapine treatment were observed. The dose of olanzapine was significantly higher in patients with changes of the EEG than in patients without changes (24.4 mg/day (SD: 8.1) vs. 12.7 mg/day (SD: 4.8); T = −4.3, df = 21, P < 0.001). In patients with EEG changes, the blood plasma concentration of olanzapine (45.6 μg/l (SD: 30.9) vs. 26.3 μg/l (SD: 21.6) tended to be also higher. The sensitivity of olanzapine dosage to predict EEG changes was 66.7%, the specificity 100% (Youden-index: 0.67). EEG abnormalities during olanzapine treatment are common. These are significantly dose dependent. Thus, EEG control recordings should be mandatory during olanzapine treatment with special emphasis on dosages exceeding 20 mg per day, although keeping in mind that EEGs have only a limited predictive power regarding future epileptic seizures.

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Section: Discussionmentioning

confidence: 99%

EEG alterations during treatment with olanzapine

Degner

Nitsche

Bias

et al. 2011

Eur Arch Psychiatry Clin Neurosci

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“…Many patients with AE will need antipsychotics to control agitation and psychosis. 1 One option is to avoid agents that lower seizure threshold (eg, clozapine and olanzapine) 2 in patients with seizures or who are at increased seizure risk (eg, patients with limbic or cortical encephalitis or who have lateralised periodic discharges (LPDs) on electroencephalogram (EEG)). Antipsychotics that prolong the QT interval (eg, ziprasidone and IV haloperidol) should be used with caution or avoided in dysautonomic patients with symptomatic bradycardia or heart block.…”

Section: Introductionmentioning

confidence: 99%

Autoimmune encephalitis: proposed recommendations for symptomatic and long-term management

Abboud

Probasco

Irani

et al. 2021

J Neurol Neurosurg Psychiatry

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The objective of this paper is to evaluate available evidence for each step in autoimmune encephalitis management and provide expert opinion when evidence is lacking. The paper approaches autoimmune encephalitis as a broad category rather than focusing on individual antibody syndromes. Core authors from the Autoimmune Encephalitis Alliance Clinicians Network reviewed literature and developed the first draft. Where evidence was lacking or controversial, an electronic survey was distributed to all members to solicit individual responses. Sixty-eight members from 17 countries answered the survey. The most popular bridging therapy was oral prednisone taper chosen by 38% of responders while rituximab was the most popular maintenance therapy chosen by 46%. Most responders considered maintenance immunosuppression after a second relapse in patients with neuronal surface antibodies (70%) or seronegative autoimmune encephalitis (61%) as opposed to those with onconeuronal antibodies (29%). Most responders opted to cancer screening for 4 years in patients with neuronal surface antibodies (49%) or limbic encephalitis (46%) as opposed to non-limbic seronegative autoimmune encephalitis (36%). Detailed survey results are presented in the manuscript and a summary of the diagnostic and therapeutic recommendations is presented at the conclusion.

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“…Olanzapine is known to cause highest EEG changes, in 35-45% of cases,[ 6 7 8 9 ] among the non-Clozapine newer antipsychotics. [ 6 7 8 9 ] Atypicals have high propensity to cause EEG changes compared to typical antipsychotics. [ 10 ] Generalized/focal symmetrical theta and delta waves are more commonly found abnormal activities followed by asymmetrical slow waves, sharp waves with phase reversals, and spike-and-slow wave patterns.…”

Section: Discussionmentioning

confidence: 99%

“…The later severe epileptic changes were noted in up to 11-15% of cases on Olanzapine. [ 4 8 9 ] EEG changes were noted at around 4-7 months of starting Olanzapine in most of the literature. [ 1 2 8 ] As abnormal EEG could be seen in most of the reported cases including our case, it would be seen beneficial to monitor EEG as a seizure preventive strategy in high-risk patients after the cost effectiveness being evaluated.…”

Section: Discussionmentioning

confidence: 99%