Zotepine-induced convulsive seizures in a chronic case of treatment resistant paranoid schizophrenia

Abstract

Adverse effects to antipsychotics are varied, frequently intolerable, often serious and sometimes fatal in clinical practice. Seizures are one of these adverse effects. Almost all first and second generation antipsychotics elicit dose-dependent lowering of seizure threshold, indicating increased seizure risk at higher drug dosages. The adverse event of zotepine induced seizure is published in few case reports. We report the occurrence of myoclonic seizure progressing to generalized tonic-clonic seizures with zotepine along with clear temporal association of dose dependent modulation evident in this case.

Association Between Antipsychotic Treatment and Neurological Adverse Events in Pediatric Patients: A Population-Based Cohort Study in Korea

“…Among atypical antipsychotic agents, risperidone showed a clear dose-response relationship with the risk of developing movement disorders (31), and olanzapine and ziprasidone were associated with risk of developing movement disorders (particularly akathisia) at higher doses (32). Likewise, the dose effect of antipsychotics on seizure incidence has been reported previously (33)(34)(35)(36)(37). For instance, clozapine exhibited a clear dose-response relationship in the increased risk of developing seizures.…”

“…The incidence rate of seizures in patients using clozapine was ∼1% when administered <300 mg/day, ∼2.5% when administered 300-599 mg/day, and ∼4.4% when administered >600 mg/day (34). Even with other antipsychotic agents, several seizure cases have been reported in patients receiving high-dose antipsychotic therapy (33,(35)(36)(37). Therefore, the American Psychiatric Association current clinical guideline recommend a low starting dose and slow dosage escalation to minimize the risk of developing seizures (38).…”

Zotepine‐induced convulsion at a low dose in a case of paranoid schizophrenia

“…Also, patients having a past history of head trauma showed a high incidence of seizure even with a daily dose of less than 300 mg of zotepine . According to the case report of Khairkar et al ., their patient developed seizures at a dose of 350 mg/day . Our patient developed seizures on increasing the dose to 150 mg/day, which is far less than the dose mentioned by Khairkar et al .…”

“…According to the case report of Khairkar et al ., their patient developed seizures at a dose of 350 mg/day . Our patient developed seizures on increasing the dose to 150 mg/day, which is far less than the dose mentioned by Khairkar et al . Seizure in our patient had a direct temporal association with zotepine at 150 mg/day without any brain pathology.…”

Effects of an Atypical Antipsychotic, Zotepine, on Astroglial L-Glutamate Release through Hemichannels: Exploring the Mechanism of Mood-Stabilising Antipsychotic Actions and Antipsychotic-Induced Convulsion

“…A study on a large sample reported that the incidence of ZTP-induced convulsion was approximately 6~17% (7/115 and 22/129) [17,18]. The risk dosage of ZTP for convulsions was over 150~350 mg/kg/day and the average duration was 21~49 days [17,62,63]. The rapid titration of doses is also a risk factor of ZTP-and clozapine-induced convulsions [60,61].…”