低劑量clozapine導致癲癇發作之案例報告與文獻回顧

Seizures Caused by Low Dose Clozapine: A Case Report and Literature Review

已知clozapine相較於其他抗精神病藥物有較高致癲癇發作的副作用發生風險，但在中低劑量使用下導致癲癇發作的情形相當少見；本文報告一位年輕病人在每日300至400mg之中劑量使用clozapine之下仍多次發生癲癇發作的情形，且經腦部電腦斷層檢查正常後確認為clozapine引起之癲癇發作。考量精神症狀控制所需而無法停換藥之前提下，最後透過逐漸降低clozapine每日劑量及合併使用抗癲癇藥物sodium valproate之下，病人未再癲癇發作且精神症狀亦獲得良好控制。特別的是，透過文獻搜尋，發現也有數篇使用中低劑量clozapine導致癲癇發作之文獻報告，且個案年紀與本案一樣屬年輕族群。

Clozapine has a well-documented pro-convulsive effect and carries a higher risk of seizures than other antipsychotics, but the occurrence of epileptic seizures in patients receiving low to medium doses is very rare. Herein, we report case involving a young patient that had multiple seizure attacks while receiving clozapine at medium dose of 300 to 400mg daily. Because the result of brain computed tomography performed to rule out other causes of seizure was normal, we assumed that the seizures were triggered by clozapine. Because there was still a need to control the patient's psychiatric symptoms, antipsychotics could not be stopped or changed. We gradually reduced the daily dose of clozapine and added the combined use of sodium valproate. The patient's seizures stopped and there was no recurrence during the follow-up period and psychotic symptoms remain under good control. A research of the literature produced several reports of seizures related to use of low to medium dose of clozapine, all in patients as young as ours. More attention may be needed when treating young people with clozapine.