Clozapine-induced seizures and treatment: a case report

A 2- year-old male patient with a five-year history of schizophrenia was brought to our clinic for delusions of reference and persecution, hostile attitudes and social isolation. Within five years, he had received various neuroleptics including risperidone, olanzapine. One year before a treatment with clozapine was commenced and the dosage was increased to 300 mg daily. When patient was brought to our clinic, he was on clozapine treatment 300 mg daily and we titrated up the clozapine treatment to 600 mg daily for six weeks after he was brought us. Patient developed tonic-clonic seizures when dosage was increased to600 mg daily. After seizure, we reduced clozapine dosage to 400 mg daily. After we decreased the dosage of clozapine our patient clinic symptoms got worsen and we re-titrated the clozapine dosage to 600 mg daily, six weeks after the seizure to maintain the therapeutic effect of clozapine. We recorded EEG one day after the seizure, EEG result was ‘normal’, and we did not add any anticonvulsant treatment because of his first seizure. After six weeks, second seizure occurred. EEG result was revealing a mild to moderate degree of common ground activity disorder and we added 1000 mg/daily valproic acid.