25. The influence of neuroleptic treatment on the occurrence of epileptic status

Abstract

Purpose: Proconvulsive and proepileptogenic effects of neuroleptics had been described a long ago. Based on the small number of studies it is estimated that patients treated with optimal therapeutic doses of commonly used neuroleptics significantly more frequently presented with transient EEG changes (7% of patients) in relation to the incidence of epileptic attacks (0.1–1.5%). The aim of our study was to verify epileptogenic impact of neuroleptic treatment in the group adolescent patients. Methods: The study included 19 adolescents with chronic neuroleptic therapy and optimal therapeutic doses. None of the patients experienced seizures before therapy. The average age of the patients was 16.5 yrs, the average therapy duration was 3 yrs. Results: 68% of the adolescents had nonspecific EEG findings. 32% had specific (bilateral epileptiform paroxysmal/nonparoxysmal) EEG changes. Half of them, with normal MRI, presented with seizures as a clinical correlate to the EEG changes (0.2% of the population). The greatest epileptogenic potential had olanzapine, chlorpromazine and haloperidol. Conclusion: In our experience, arising from this study, proepileptogenic and proconvulsive effects of neuroleptics were once again confirmed, particularly strong among adolescents, suggesting an important receptor hypersensitivity likely caused by endogenous and biological factors (age, hormonal status, the dynamic body mass, volume changes, etc).