Electroencephalographic Abnormalities in Clozapine-Treated Patients: A Cross-Sectional Study

Goyal, Nishant; Praharaj, Samir Kumar; Desarkar, Pushpal; Nizamie, Haque S

doi:10.4306/pi.2011.8.4.372

Cited by 18 publications

(12 citation statements)

References 37 publications

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“…EEG abnormalities such as spikes and sharp waves indicate a increased risk of convulsions. Other studies show that EEG abnormalities may be present without any association with clinical seizures 25–27). In this case, while EEG pathology was not detected before starting clozapine, no EEG monitoring was performed while using the drug.…”

Section: Discussionmentioning

confidence: 69%

“…Also, drugs interfering with cytochrome P450 1A2 may increase or decrease the plasma levels of clozapine. Thus, therapeutic drug monitoring of clozapine has been suggested to predict the onset of seizures 27,29). In case of developing epileptic seizures during clozapine treatment, clozapine dose reduction, changing clozapine with another antipsychotic drug or adding antiepileptics to the treatment are recommended 30).…”

Section: Discussionmentioning

confidence: 99%

“…We started sodium valproate as standard dose level for the prevention of seizures occurring due to the use of clozapine 7). Antiepileptic prophylaxis in patients using clozapine without clinical seizures can be performed in such cases at a certain clozapine dose or plasma level (>500 μg/L) or the appearance of clear epileptiform discharges on EEG 27,28)…”

Section: Discussionmentioning

confidence: 99%

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Low-dose Clozapine-induced Seizure: A Case Report

Bolu

Akarsu

Pan

et al. 2017

Clin Psychopharmacol Neurosci

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Seizures are believed to be a dose-dependent side effect of clozapine. In this case report, we describe a patient who had tonic-clonic seizures after using a low dose clozapine who did not have any seizure risk. The 29-year-old male patient had been followed-up with a diagnosis of schizophrenia for about 5 years. When using clozapine 200 mg/day he had a tonic-clonic seizure with bilateral diffuse epileptic activity in electroencephalography (EEG). In the literature, there are a few case reports about low-dose clozapine-induced seizure. Seizures were observed in our case with a low dose of clozapine (200 mg/day) making this case remarkable. EEG monitoring at regular intervals and examination of plasma levels of clozapine could be useful in preventing the development of seizures.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Low-dose Clozapine-induced Seizure: A Case Report

Bolu

Akarsu

Pan

et al. 2017

Clin Psychopharmacol Neurosci

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“… 2 , 22 – 24 However, Centorrino et al 21 did not find a relationship between dose and EEG abnormalities. Goyal et al 25 reported EEG abnormalities in 61.9% of patients receiving clozapine at a dose of 100 mg or less. In this study, the mean dose of clozapine at the occurrence of EEG abnormalities varied from 125–600 mg (mean 305 mg/day) and was lower than that in the normal EEG group (mean 378.1 mg/day), albeit not significantly.…”

Section: Discussionmentioning

confidence: 99%

Clozapine-induced seizures, electroencephalography abnormalities, and clinical responses in Japanese patients with schizophrenia

Kikuchi¹,

Sato²,

Ataka³

et al. 2014

NDT

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PurposeWe describe electroencephalography (EEG) abnormalities and seizures associated with clozapine treatment in Japanese patients with schizophrenia and retrospectively compare EEG results and total Positive and Negative Syndrome Scale (PANSS [T]) scores before and after treatment.MethodsTwenty-six patients with treatment-resistant schizophrenia were enrolled in this study. EEG measurements were obtained prior to clozapine treatment and every 4 weeks thereafter. EEG measurements were also obtained at the time of seizure. After seizures or EEG abnormalities were noted, additional EEGs were performed every 2 weeks. PANSS (T) scores were used to determine clozapine treatment outcome.ResultsAll 26 patients had normal baseline EEG measurements, and ten patients (38.5%) later manifested EEG abnormalities. The mean age was significantly lower than in the abnormal EEG group. Six patients (23.1%) experienced seizures. The mean dose of clozapine at the first occurrence of seizure was 383.3 mg/day. Five of six patients who experienced seizures in this study were successfully treated with valproate or lamotrigine without discontinuation of clozapine. The one patient who continued to experience seizures was successfully treated without antiepileptic drugs. The mean baseline PANSS (T) scores were not significantly different between the normal and abnormal EEG groups, but the mean score in the abnormal EEG group was significantly lower than that in the normal EEG group at the final follow-up (P=0.02).ConclusionEEG abnormalities may appear in younger patients, and our findings indicate that there is no need to discontinue clozapine when seizures occur. EEG abnormalities that appeared after clozapine treatment were associated with a good clinical response.

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“…Although independently all EEG parameters show worsening, none of these have been found to be significant in predicting response to clozapine on clinical parameters. Although many studies have shown a positive association in this regard[ 26 27 28 ], others have observed negative results. Another study from a cohort of 15 patients reported that EEG abnormalities occurred more frequently (64%) in schizophrenic patients who receive clozapine, yet the EEG changes do not necessarily predict the occurrence of convulsions.…”

Section: Discussionmentioning

confidence: 99%

Clozapine response and pre-treatment EEG-is there some kind of relationship

et al. 2014

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Background:Clozapine has been used widely in the management of treatment-resistant schizophrenia. The present study aims at determining whether pre-treatment electroencephalography (EEG) abnormalities would serve as a marker for response to clozapine treatment.Subjects and Methods:This was a cross-sectional study done in a tertiary care center in Mumbai where patients diagnosed with schizophrenia using DSM-IV criteria and resistant schizophrenia using Kane criteria were assessed using EEG prior to starting clozapine treatment. They were rated for symptomatic improvement using the Positive and Negative Syndrome Scale (PANSS) along with Clinical Global Improvement for Severity (CGI-S). The results were statistically analysed and presented.Results:55 out of the 80 patients in the study showed baseline EEG abnormalities. The mean duration of illness in the patients were 2.65 years. Slow wave and background EEG abnormalities were common in pre-treatment EEG. 36.4% patients in the study showed clinical response. Patients with negative symptoms and baseline EEG abnormalities showed better response.Conclusions:The study was circumscribed and had many limitations due to a small sample size. The relation between pre-treatment EEG abnormalities and clozapine response could not be statistically correlated and it could not be ascertained to be a marker for response to clozapine therapy.

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Electroencephalographic Abnormalities in Clozapine-Treated Patients: A Cross-Sectional Study

Cited by 18 publications

References 37 publications

Low-dose Clozapine-induced Seizure: A Case Report

Low-dose Clozapine-induced Seizure: A Case Report

Clozapine-induced seizures, electroencephalography abnormalities, and clinical responses in Japanese patients with schizophrenia

Clozapine response and pre-treatment EEG-is there some kind of relationship

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