Reactions 1319 - 18 Sep 2010

SClomipramine/clozapine

Speech disorders and tonic-clonic epilepsy: casereport

A 15-year-old boy with schizophrenia developed tardivespeech dysfluency and generalised tonic-clonic seizuresduring treatment with clomipramine and clozapine.

The boy received a combined treatment forschizophrenia, consisting of clomipramine 225 mg/day andclozapine 350 mg/day [routes not stated], followingpersistent obsessive-compulsive symptoms andantipsychotic treatment resistance. Three years afterstarting combined therapy, he developed facial tic-likemovements, involuntary paroxysmal perioral movements,myoclonic jerks of his arms and dysfluent speech, withtransient speech rate acceleration and stutter-likerepetition of syllables. Drug-induced tardive dyskinesiawas suspected.

The boy received vitamin E, but his symptoms did notimprove; his motor symptoms persisted for 5 months.Following a generalised tonic-clonic seizure, clozapine wasreduced to 300 mg/day, but he soon experienced anotherseizure. Electroencephalography showed frequentgeneralised and multifocal paroxysmal epileptiformdischarges and diffuse background slowing. His motorsymptoms were attributed to epileptic activity. Valproicacid was started and, within days, his motor and speechdisorders had resolved. Two years later, he remainedseizure-free.

Author comment: "The additive effect of combinedclozapine-clomipramine therapy could have induced thisepileptic syndrome in a nonepileptic patient by markedlyreducing the seizure threshold."Horga G, et al. Drug-induced speech dysfluency and myoclonus precedinggeneralized tonic-clonic seizures in an adolescent male with schizophrenia. Journalof Child and Adolescent Psychopharmacology 20: 233-234, No. 3, Jun 2010.Available from: URL: http://dx.doi.org/10.1089/cap.2009.0010 - Spain 803038578

1

Reactions 18 Sep 2010 No. 13190114-9954/10/1319-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved