New-onset Seizures and EEG findings in Clozapine Therapy
Abstract number :
2.468
Submission category :
6. Cormorbidity (Somatic and Psychiatric)
Year :
2022
Submission ID :
2233035
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:29 AM
Authors :
Carlos Soto Rincón, MD – National Institute of Neurology and Neurosurgery; Carlos Luis Cervantes, M.D. – National Institute of Neurology; Daniel San-Juan, MD, MSc – Consultant, Epilepsy Clinic, National Institute of Neurology and Neurosurgery; Alejandro Lopez-Landa, MD – cFaculty of Medicine, Benemérita Universidad Autónoma de Puebla; Monsterrat Mondragon, MD – Psychiatry department – National Institute of Neurology and Neurosurgery
This is a Late Breaking abstract
Rationale: Clozapine (CZP) is an FDA-approved atypical antipsychotic medication for treatment-resistant schizophrenia, which exerts its effects blocking of 5-HT2A/5-HT2C serotonin, D1-4 dopamine, M1-5 muscarinic, histamine, and alpha-1 adrenergic receptors. However, CZP is used in other neuropsychiatric conditions, including patients with epilepsy. Unfortunately, the side effects of CZP are diverse, ranging from weight gain, severe neutropenia, and seizures. New-onset seizures secondary to CZP is estimated 1.3% to 2.8% of implying early withdrawal of CZP therapy. Although the effects of CZP in patients with epilepsy is scare, some authors have suggested a routine scalp EEG during CZP therapy, moreover, the lack of any biomarker of assessment of the patients at risk of new-onset seizures or in patients with epilepsy is poor defined. Hence, the main objective of this study is to help determine the prevalence of new-onset seizures and EEG findings in patients with and without epilepsy starting CZP.
Methods: We conducted the retrospective study during 2010-2022 at the National Institute of Neurology and Neurosurgery in Mexico City. We included adults (≥18 years-old) starting CZP with a standard scalp EEG during their treatment. We recorded the clinical variables (age, sex, diagnosis, seizure, and history of epilepsy), hematological measurements, and EEG findings. Descriptive statistics were utilized.
Results: A total of 62 patients were analyzed: a total mean of 35.9±15 years old and 51% female, the primary diagnosis was 16/62 (25%) schizophrenia and 26/62 (41%) interictal epilepsy psychosis taking a mode of 200mg (25-500 mg) of CZP. Only 6 (9.6%) patients developed mild anemia (Hb 10-13 gr/dl) and 12 (19%) had mild lymphocytopenia during the CZP treatment. Fifty-one percent of patients had subsequently seizures; 23/62 (37%) had a history of epilepsy and 7/62 (11.2%) didn’t have it. Scalp EEG abnormalities were found in 58.2% of patients. The generalized slowing was seen in 58.2% and interictal epileptiform discharges in 17.9%. However, only 2/7 (28%) patients had IEDs in the EEG without previous history of epilepsy.
Conclusions: We found a high prevalence of new-onset seizure in patients without previous history of epilepsy (11.2%) and only a quarter had IEDs during CZP therapy. The comorbidity of epilepsy and other neuropsychiatric disorders is common and complex.
Funding: None
Cormorbidity (Somatic and Psychiatric)