Le DS, Su H, Liao ZL, Yu EY. Low-dose clozapine-related seizure: A case report and literature review . World J Clin Cases 2021; 9(20): 5611-5620 [PMID: 34307616 DOI: 10.12998/wjcc.v9.i20.5611]
Corresponding Author of This Article
En-Yan Yu, MM, Chief Physician, Professor, Department of Psychiatry, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, No. 1 East Banshan Road, Gongshu District, Hangzhou 310022, Zhejiang Province, China. yuenyan@aliyun.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 16, 2021; 9(20): 5611-5620 Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5611
Low-dose clozapine-related seizure: A case report and literature review
Dan-Sheng Le, Heng Su, Zheng-Luan Liao, En-Yan Yu
Dan-Sheng Le, The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou 310051, Zhejiang Province, China
Heng Su, Zheng-Luan Liao, Department of Psychiatry, Zhejiang Provincial People’s Hospital, Hangzhou 310000, Zhejiang Province, China
En-Yan Yu, Department of Psychiatry, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou 310022, Zhejiang Province, China
Author contributions: Le DS conceived the central idea, analyzed clinical data and wrote the initial draft; all authors participated in clinical diagnosis and revised the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: En-Yan Yu, MM, Chief Physician, Professor, Department of Psychiatry, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, No. 1 East Banshan Road, Gongshu District, Hangzhou 310022, Zhejiang Province, China. yuenyan@aliyun.com
Received: February 8, 2021 Peer-review started: February 8, 2021 First decision: March 27, 2021 Revised: April 7, 2021 Accepted: May 20, 2021 Article in press: May 20, 2021 Published online: July 16, 2021 Processing time: 148 Days and 16.6 Hours
Abstract
BACKGROUND
Treatment-resistant schizophrenia is a severe form of schizophrenia characterized by poor response to at least two antipsychotic drugs and is typically treated with clozapine. However, clozapine lowers the epileptic threshold, leading to seizures, which are severe side effects of antipsychotics that result in multiple complications. Clozapine-related seizures are generally considered to be dose-dependent and especially rare in the low-dose (150-300 mg/d) clozapine treated population. Due to clinical rarity, little is known about its clinical characteristics and treatment.
CASE SUMMARY
A 62-year-old Chinese man with a 40-year history of treatment-resistant schizophrenia presented to the Emergency Department with symptoms of myoclonus, consciousness disturbance and vomiting after taking 125 mg clozapine. Upon admission, the patient had a suddenly generalized tonic-clonic seizure lasting for about half a minute with persistent disturbance of consciousness, fever, cough and bloody sputum, which was considered to be low-dose clozapine-related seizure. After antiepileptic and multiple anti-infection treatments, the patient was discharged without epileptic or psychotic symptoms.
CONCLUSION
Our aim is to highlight the early prevention and optimal treatment of clozapine-related seizure through case analysis and literature review.
Core Tip: Clozapine-related seizure is a serious adverse reactions of clozapine, which should be given more attention to its early prevention and optimal treatment. Clinical features, treatment options and factors that may contribute to the development of clozapine-related seizures were summarized through case analysis and literature review, and relevant cases published in the last 20 years were summarized and listed.
