Control of seizures in a clozapine-treated schizophrenia patient, using valproate: a case report

摘要

Schizophrenia is characterized by an adverse clinical course and poor psychosocial functioning,and causes problems in the social-cognitive sphere. Clozapine is a potent antipsychotic agentused in the treatment of psychotic disorders when other antipsychotic agents failed. It is seenthat clozapine causes more seizures at therapeutic doses when compared to standardantipsychotic agents. Various mechanisms have been proposed for seizure onset. Clozapinecan induce epileptogenic activity by inhibiting D4 receptors in mesolimbic system andcortex. Clozapine does not only exert its effects on H1 and Ach-Mus receptors but also onseveral receptors such as gamma-aminobutyric acid A, nicotinic acetylcholine, glutamate,and N-methyl-D-aspartate. Here, we discussed a woman with schizophrenia in whom atonicseizure was developed during clozapine treatment and treated successfully by valproic acid/sodium valproate. Atonic seizures should be considered in patients who have drop attacksduring clozapine therapy and atonic seizures should be treated by using an anticonvulsantagent such as valproic acid/sodium valproate when it is inappropriate to reduce clozapinedose.