However, a relationship between dose and occurrence of seizures was not found. We consider that clozapine level is likely to be the more reliable indicator of the potential for seizure to occur. There is a distinct lack of studies investigating the relationship between clozapine plasma levels and occurrence of seizures. Additional large-scale studies are required to establish with certainty the relationship between clozapine and seizures. For seizure prophylaxis, there appears to be a strong argument for prescribing an

Inhibitors,research,lifescience,medical AED after the occurrence of myoclonus, stuttering or speech difficulties, any type of seizure, epilepti-form changes on the EEG, and in those with added risk factors such as pre-existing seizure disorder or those with relevant neurological abnormalities, and also once the clozapine plasma level reaches or exceeds 500 μg/l. The AEDs of choice appear to be valproate for a schizoaffective illness, topiramate or lamotrigine

for patients with clozapine-induced Inhibitors,research,lifescience,medical weight gain, and lamotrigine in clozapine-refractory schizophrenia. When should an antiepileptic be prescribed? In pre-existing seizure disorder or in patients with relevant neurological abnormalities. With concurrent use of epileptogenic medication. When clozapine plasma level exceeds 500 μg/l. If stuttering Inhibitors,research,lifescience,medical or other speech see more difficulties occur. If myoclonic jerks occur. If EEG shows epileptiform changes. Following any type of

seizure. In clozapine treatment-refractory schizophrenia, augment with lamotrigine. Antiepileptic choice Schizoaffective disorder or mood-related psychosis: valproate. Clozapine-induced Inhibitors,research,lifescience,medical weight gain: lamotrigine or topiramate Lack of response with clozapine: lamotrigine. Acknowledgement The authors wish to thank Victoria Cornelius for her statistical advice. Footnotes This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. None declared.
A pro forma for data extraction at baseline was designed to enhance reliability and included the following variables. Oxygenase Inhibitors,research,lifescience,medical Sample characteristics. Sociodemographic variables included gender, date of birth, marital status, employment status, and ethnicity which was categorized using standard format from census data [Office for National Statistics, 2001]. Primary psychiatric diagnosis at CTO initiation was recorded as documented by clinicians (ICD-10) [World Health Organization, 1992]. Mental Health Act status. Date of CTO initiation, reasons for CTO (protection of patient’s own safety, health or others), preceding/parent section (sections 3, 37 or 25a) and CTO specified conditions were noted. Medication. Psychotropic medication prescribed at the time of CTO initiation (drug name and dose), history of previous clozapine (ever) use, and history of previous antipsychotic LAI (ever) use were recorded.