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Clozapine Safety and Efficacy for Interictal Psychotic Disorder in Pharmacoresistant Epilepsy

Jetté Pomerleau, Vincent MSc*; Dubeau, François MD, FRCP(C); Ducharme, Simon MD, MSc, FRCP(C)†,‡

Cognitive And Behavioral Neurology: June 2017 - Volume 30 - Issue 2 - p 73–76
doi: 10.1097/WNN.0000000000000127
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Since the middle of the 19th century, both neurologists and psychiatrists have linked psychosis and epilepsy. Clozapine, the most effective antipsychotic drug, alters electroencephalographic activity and carries a significant risk of causing seizures. Unfortunately, this risk limits the drug’s potential use in treating pharmacoresistant psychosis in patients with epilepsy. We present a unique case in which we used clozapine successfully as a last resort treatment for chronic interictal psychosis in a 43-year-old woman with severe pharmacoresistant epilepsy and recurrent status epilepticus. Her psychotic symptoms improved markedly without an increase in the frequency of seizures despite gradual titration of the clozapine dose up to 300 mg daily. Her response demonstrates that, properly monitored, clozapine can be an effective treatment for psychosis even in patients with daily seizures.

*Department of Medicine, University of Montreal

Departments of Neurology & Neurosurgery

Psychiatry, McGill University Health Centre and Montreal Neurological Hospital and Institute, McGill University; Montreal, Quebec, Canada

S.D. receives salary support from the Fonds de Recherche du Québec—Santé.

The authors declare no conflicts of interest.

Reprints: Simon Ducharme, MD, MSc, FRCP(C), 3801 University Street, Montreal, Quebec, Canada H3A 2B4 (e-mail: simon.ducharme@mcgill.ca).

Received November 30, 2016

Accepted April 5, 2017

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