Clozapine
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Drop attacks: 2 case reports Two men experienced drop attacks during treatment with clozapine [duration of therapy to reaction onset not clearly stated]. A 74-year-old man with a history of catatonic schizophrenia started receiving clozapine titrated up to 600 mg/day over a 6-week period; concomitant medications included haloperidol, biperiden and valproic acid. At a clozapine dosage of 600 mg/day, he started to experienced drop attacks, which involved falling to his knees from a standing position while fully alert. These attacks occurred several times a day and he was hospitalised. EEG findings did not reveal any evidence of seizures or cortical myoclonus. Clozapine was tapered and discontinued and he received quetiapine. After clozapine cessation, he stopped experiencing drop attacks. A 56-year-old man with a history of bipolar disorder started receiving clozapine titrated up to 500 mg/day over a 6-week period; concomitant medications included haloperidol, biperiden and valproic acid At a clozapine dosage of 500 mg/day, he started to experienced drop attacks, which involved falling to his knees from a standing position while fully alert. He experienced several attacks a day and was hospitalised. EEG results did not show any evidence of cortical myoclonus or seizures. Clozapine was titrated down and eventually discontinued and he received quetiapine. Following clozapine discontinuation, his drop attacks disappeared. Author comment: "Use of the Naranjo scale for clinical decision-making, revealed a probable relationship between clozapine and manifestation of [drop attacks]. . . We herein suggest that [drop attacks] were probably clozapine-related and postulate that the pathophysiology is similar to that of the drug-induced [negative myoclonus]." Giannakopoulou F, et al. Clozapine-induced non-epileptic drop attacks: report of two cases. European Journal of Neurology 14: E13, No. 9, Sep 2007 801091898 Greece
0114-9954/10/1176-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 3 Nov 2007 No. 1176
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