Clozapine for treatment-resistant schizophrenia with epilepsy: A case report.

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PCN reports : psychiatry and clinical neurosciences Pub Date : 2026-04-07 eCollection Date: 2026-06-01 DOI:10.1002/pcn5.70330

Toru Horinouchi, Mayusa Mito, Toshiyuki Ishikawa, Yuichi Nakamura, Shuhei Ishikawa, Naoki Hashimoto

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Abstract

Background: Treatment-resistant schizophrenia (TRS) poses a substantial clinical challenge for which clozapine (CLOZ) is the only effective treatment. However, clinicians may hesitate to prescribe CLOZ for TRS patients with epilepsy due to its presence because CLOZ is contraindicated in patients with uncontrolled epilepsy in some countries including Japan.

Case presentation: A 36-year-old male with TRS and focal epilepsy underwent CLOZ therapy. CLOZ was initiated at 6.25 mg and gradually titrated to 250 mg over 3 months, achieving a plasma concentration of 449 ng/mL. Psychotic symptoms improved without worsening of seizure frequency or severity. Mild side effects such as drowsiness and drooling were manageable. Long-term video electroencephalography monitoring detected spike-and-wave activity centered in the frontal region, but did not detect any overt epileptic seizures.

Conclusion: We report a case of TRS with comorbid epilepsy in which CLOZ therapy was both effective and safe.

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氯氮平治疗难治性精神分裂症伴癫痫1例。

背景：难治性精神分裂症（TRS）是一个重大的临床挑战，氯氮平（CLOZ）是唯一有效的治疗方法。然而，由于CLOZ的存在，临床医生可能会犹豫是否给TRS癫痫患者开CLOZ，因为在包括日本在内的一些国家，CLOZ是未控制癫痫患者的禁忌症。病例介绍：一位36岁男性TRS合并局灶性癫痫患者接受CLOZ治疗。CLOZ起始剂量为6.25 mg， 3个月后逐渐滴定至250 mg，血药浓度达到449 ng/mL。精神病症状得到改善，但癫痫发作频率或严重程度没有恶化。轻微的副作用，如嗜睡和流口水是可控的。长期视频脑电图监测检测到以额叶区域为中心的尖波活动，但未发现任何明显的癫痫发作。结论：我们报告了一例TRS合并癫痫的病例，CLOZ治疗既有效又安全。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

PCN reports : psychiatry and clinical neurosciences

CiteScore

0.70

自引率

0.00%

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