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

Abstract

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 agent used in the treatment of psychotic disorders when other antipsychotic agents failed. It is seen that clozapine causes more seizures at therapeutic doses when compared to standard antipsychotic agents. Various mechanisms have been proposed for seizure onset. Clozapine can induce epileptogenic activity by inhibiting D4 receptors in mesolimbic system and cortex. Clozapine does not only exert its effects on H1 and Ach-Mus receptors but also on several receptors such as gamma-aminobutyric acid A, nicotinic acetylcholine, glutamate, and N-methyl-D-aspartate. Here, we discussed a woman with schizophrenia in whom atonic seizure was developed during clozapine treatment and treated successfully by valproic acid/sodium valproate. Atonic seizures should be considered in patients who have drop attacks during clozapine therapy and atonic seizures should be treated by using an anticonvulsant agent such as valproic acid/sodium valproate when it is inappropriate to reduce clozapine dose.

Keywords

• clozapine
• valproic acid
• atonic seizures
• schizophrenia