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Clorapine is an atypical antipsychotic agent associated with a higherfrequency ofseizures than standard neuroleptics. In addition, clozapinecauses epileptiform abnormalities in the EEG in up to 72% qf patients. A patient who developed a generalized seizure shortly after beginning clozapine treatment and the patient's EEG fi ndings are presented. The neuropharmacology qf dozapine and the management ofcioeapine-induced seizures and EEG abnormalities are discussed. C lozapine (C lozaril) is a unique ant ipsychotic whi ch has been shown to be effec t ive in th e treatment of refract ory schizo phe nia ( 1,2). Com pa red with standard neuroleptics clozapine has minimal ext ra pyra midal side effects a nd poses a low risk for tardive dysk inesia (1,3,4,5,6). Develop ed in 1960, clozapine was delayed from earl ie r wid esp read use by it s side effec t profile. The most dangerous of th e com mo n side effects is agranu locytosis , which has been re po rted in I% to 2% of cas es (7). Other adverse effects include hypotension, fatigu e, drug fever, pharmacogenic delirium, tachycardia, a nd seizu res . Associat ed se izu re s have be en found in 4% of U.S . cases (7) com pa red to I% to 2% in standard neurolept ics (8) . Data from th e manufacturer, Sandoz, indicat es tha t these seizures are dos e dependent with patients treated with 600 to 900 mg/day having a se izu re fr equency of 5%; those treated with 300 to 599 mg/day, 3-4%; a nd those patients treated with less than 300 mg/day having a se izu re frequency of 12% (9). A sim ilar dos e depen den t frequ ency was found by Devinsky et aI, who also sugges t that rapid upward titrat ion of cloz apine may incr ease se izu re risk ( 10) . EEG abnorma liti es have been not ed in 72% of patient s on clozapine (II) . T he EEG typicall y shows slow waves a nd paroxysmal d isch a rg es whi ch may ap pear to be epilep tifor m. As clozapine use incr eases, th e issue of how to man age clozapineinduced seizures and EEG changes becomes a n important clinica l pro blem . In this report we present th e case of a pat ient who had a se izu re while on a low do se of clozapine and an abnormal EEG wh ich persisted for weeks a fter her last seizure. This is follow ed by a discu ssion of th e unique pr op erties of clozapine which

Clozapine-Induced Seizures and EEG Changes: A Case Report and Discussion of Clinical Management