Wong Jason, Delva Nicholas
Providence Continuing Care Centre Mental Health Services, Kingston, Ontario, Canada.
Can J Psychiatry. 2007 Jul;52(7):457-63. doi: 10.1177/070674370705200708.
To inform clinicians about the types of seizures that can be induced by clozapine and to provide recommendations for treatment.
We identified articles on clozapine-induced seizures from a MEDLINE search of the English-language literature from 1978 to July 2006. The frequency of each type of seizure and the dosages of clozapine associated with seizures were compiled. In addition to this review, we report a new case illustrating the challenge of diagnosing subtle seizure activity.
The tonic-clonic variety is the most frequently described clozapine-induced seizure. Myoclonic and atonic seizures together constitute about one-quarter of the reported seizures. The mean dosage of clozapine associated with seizures is not high (less than 600 mg daily).
It may be difficult for clinicians to recognize subtle types of clozapine-induced seizures, such as myoclonic, atonic, or partial seizures. Clinicians should not place excessive reliance on the plasma level of clozapine or electroencephalogram findings to predict the occurrence of seizures. When a first seizure occurs, it is recommended that the dosage of clozapine be reduced or an alternative antipsychotic agent be employed. If a second seizure occurs, an anticonvulsant drug should be started. Special attention should be paid when commencing or discontinuing concurrent medication that may affect the plasma level of clozapine.
告知临床医生氯氮平可诱发的癫痫发作类型，并提供治疗建议。
我们通过检索1978年至2006年7月的英文医学文献数据库MEDLINE，确定了有关氯氮平诱发癫痫发作的文章。汇总了每种癫痫发作类型的频率以及与癫痫发作相关的氯氮平剂量。除了这篇综述外，我们还报告了一个新病例，以说明诊断细微癫痫活动的挑战。
强直阵挛型是最常被描述的氯氮平诱发的癫痫发作类型。肌阵挛性发作和失张力性发作加起来约占报告的癫痫发作的四分之一。与癫痫发作相关的氯氮平平均剂量不高（每日少于600毫克）。
临床医生可能难以识别氯氮平诱发的细微癫痫发作类型，如肌阵挛性、失张力性或部分性发作。临床医生不应过度依赖氯氮平的血药浓度或脑电图结果来预测癫痫发作的发生。首次癫痫发作时，建议减少氯氮平剂量或使用替代抗精神病药物。如果发生第二次癫痫发作，应开始使用抗惊厥药物。开始或停用可能影响氯氮平血药浓度的同时使用的药物时，应特别注意。
