Toth P, Frankenburg F R
Department of Medical Education, North York General Hospital, University of Toronto, Ontario.
Can J Psychiatry. 1994 May;39(4):236-8. doi: 10.1177/070674379403900409.
Clozapine, a novel antipsychotic agent, is an alternative to standard neuroleptic therapy for psychotic disorders. Some advantages of clozapine over neuroleptics are that it may be a more effective antipsychotic in treatment resistant patients and has a lower incidence of extrapyramidal side effects. However, seizures associated with clozapine treatment occur at a rate of about three percent. Factors which seem to increase the likelihood of seizures include high doses of clozapine, rapid dose titration, the concurrent use of other epileptogenic agents and a previous history of neurological abnormalities. A strategy that has been proposed to reduce the occurrence of seizures is the addition of an anticonvulsant agent. At present, little rigorous scientific evidence exists to establish the effectiveness of this strategy or the choice of an anticonvulsant. However, based on what evidence there is and the side effect profiles of the various anticonvulsants, the authors propose the use of valproic acid for the prophylaxis and management of clozapine related seizures.
氯氮平是一种新型抗精神病药物，是治疗精神障碍的标准抗精神病药物疗法的替代药物。氯氮平相对于抗精神病药物的一些优势在于，它可能是治疗难治性患者更有效的抗精神病药物，且锥体外系副作用的发生率较低。然而，氯氮平治疗相关的癫痫发作发生率约为3%。似乎会增加癫痫发作可能性的因素包括高剂量氯氮平、快速滴定剂量、同时使用其他致癫痫药物以及既往有神经学异常病史。为减少癫痫发作的发生而提出的一种策略是添加抗惊厥药物。目前，几乎没有严格的科学证据来证实该策略的有效性或抗惊厥药物的选择。然而，基于现有的证据以及各种抗惊厥药物的副作用情况，作者建议使用丙戊酸来预防和管理与氯氮平相关的癫痫发作。
