Klozapín je atypické neuroleptikum, ktoré vyvolává zriedkavejšie extrapyramídové nežiaduce účinky ako klasické neuroleptiká. Predsa však liečba klozapínom je spojená s neobvykle vysokým výskytom EEG (elektroencefalografických) abnormít a s poměrné vysokým rizikom epileptických paro-xyzmov [26]. O klinickom význame zmien EEG počas liečby klozapínom sa diskutuje mnoho rokov [3, 8, 23, 24, 32]. Cielom nasej štúdie bolo sledovanie zmien EEG v róznych štádiách liečby klozapínom a pokusili sme sa tiež zistit, či existujú dóležité vztahy medzi změnami EEG a dalšími klinickými charakteristikami. V súbore 65 pacientov (vo veku 18-59 r., 37 M, 28 Ž) v róznych štádiách liečby klozapínom boli hod-notené rutinné EEG záznamy snímané v bdelom relaxovanom stave. EEG nálezy boli hodnotené ako normálně (13 záznamov) alebo patologické. Patologické záznamy boli rozdělené následovně: 1. Bilaterálně alebo generalizované "spomalenie" (25 záznamov). 2. Paroxyzmálna - bilaterálna alebo generalizovaná - pomalá aktivita (17 záznamov). 3. Ostré grafoelementy alebo komplexy hrotov/ostrých vln a pomalých vln (10 záznamov). EEG abnormity boli častejšie u pacientov, ktorí užívali vyššie dávky klozapínu (> 300 mg/d), ale vyskytli sa aj na začiatku liečby (u jedného pacienta pri dennej dávke klozapínu 25 mg). U žiadneho z pacientov sa neobjavili epileptické paroxyzmy. Naše zistenia naznačujú, že změny EEG počas liečby klozapínom sú ovplyvnené aj dalšími faktormi.
Clozapine is an atypical antipsychotic drug that is less likely to cause extrapyramidal side effects than classic neuroleptics. However, treatment with clozapine is associated with unusually high incidence of EEG abnormalities and with relatively high risk of epileptic seizures [26]. Clinical importance of EEG alterations during treatment with clozapine has been discussed for many years [3, 8, 23, 24, 32]. The aim of our study is to follow EEG changes in different stages of treatment with clozapine and to find out, whether there are some important correlates between EEG alterations and clinical data. In a group of 65 patients (18-59 y, 37 M, 28 F) in a different stages of treatment with clozapine (daily doses 25-699 mg) routine awake EEG recordings were performed. EEG were classified as normal (13 records) or abnormal. Abnormal tracings were subdivided as follows: 1. Bilateral or generalized slowing (25 records). 2. Paroxysmal - bilateral or generalized - slow activity (17 records). 3. Sharp waves or complexes of spikes/sharp waves and slow waves (10 records). EEG abnormalities were more frequent in patients with higher doses of clozapine (> 300 mg/d), but developed even at the begining of therapy (in one patient at daily dose of clozapine 25 mg). None of the patients suffered from ictal events. Our results suggest that EEG changes during clozapine treatment are influenced not only by clozapine itself, but other factors may play a role.
- MeSH
- Antipsychotic Agents pharmacology adverse effects therapeutic use MeSH
- Adult MeSH
- Electroencephalography methods MeSH
- Drug Therapy methods MeSH
- Drug Evaluation MeSH
- Clozapine pharmacology adverse effects therapeutic use MeSH
- Humans MeSH
- Retrospective Studies MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- MeSH
- Adult MeSH
- Clozapine administration & dosage adverse effects MeSH
- Humans MeSH
- Schizophrenia drug therapy MeSH
- Tranquilizing Agents drug therapy MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Adult MeSH
- Clozapine administration & dosage therapeutic use MeSH
- Pregnancy Complications MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Risk MeSH
- Schizophrenia drug therapy MeSH
- Pregnancy MeSH
- Heart Defects, Congenital MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Je popsán případ pacientky se schizofrenií, u které došlo během léčby klozapinem k rozvoji parkinsonského syndromu. Atypičnost výskytu extrapyramidové symptomatiky při léčbě klozapinem vedla k úvaze o komorbiditě schizofrenie a Parkinsonovy choroby. Význam sdělení spočívá v popisu relativně vzácné komorbidity schizofrenního onemocnění a idiopatické Parkinsonovy choroby a ukazuje možnost využití nerutinního vyšetření hustoty a distribuce dopaminových transportérů jednofotonovou emisní výpočetní tomografií (SPECT) v diferenciální diagnóze parkinsonizmu.
The case of female schizophrenic patient who developed parkinsonism during clozapine treatment is described. Atypical occurrence of extrapyramidal syndrome during clozapine treatment led us to consideration comorbidity of schizophrenia and Parkinson´s disease. The importance of case report consists in description of relatively uncommon comorbidity of schizophrenia and Parkinson´s disease and in possibility of application not routine examination of the density and distribution dopamine transporters by single photon emission tomogreaphy in differential diagnosis of parkinsonism.
- MeSH
- Clozapine administration & dosage adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Parkinsonian Disorders drug effects MeSH
- Schizophrenia drug therapy complications MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Biomedical Research MeSH
- Tranquilizing Agents administration & dosage MeSH
- Publication type
- Comparative Study MeSH
Léčba klozapinem je spojena s metabolickými nežádoucími účinky. Nárůst hmotnosti, hyperglykemie a hyperlipidemie jsou rizikem pro vznik diabetů a kardiovaskulárních onemocnění. Popisujeme případ nemocného léčeného kombinací klozapinu s aripiprazolem. Po dvou měsících od nasazení aripiprazolu došlo k významnému poklesu hmotnosti a úpravě hladín cholesterolu a triglyceridů. Zaznamenali jsme také zlepšení negativní symptomatiky. Naše zkušenost v souhlasu s literárními údaji podporuje možnost použít tuto kombinaci v případe, kdy není možné klozapin zaměnit za jiné antipsychotikum.
Clozapine treatment can be associated with the metabolic side effects. Weight gain, hyperglycemia and hyperlipidemia are the ri sk factors for onset of diabetes and cardiovascular disorders. We report a case vignette of a patient treated with combination of clozapi- ne and aripiprazole. The significant decrease of weight, cholesterol and triglyceride serum concentrations occured two months a fter coadministration of aripiprazole. The improvement of negative symptoms was found, too. Our case, in agreement with published da ta, supports this combined therapy when is not possible to replace clozapine by other antipsychotic.
- MeSH
- Antipsychotic Agents administration & dosage pharmacology therapeutic use MeSH
- Adult MeSH
- Hyperlipidemias etiology prevention & control MeSH
- Clozapine administration & dosage pharmacology therapeutic use MeSH
- Drug Therapy, Combination MeSH
- Humans MeSH
- Metabolic Diseases etiology prevention & control MeSH
- Drug Monitoring methods utilization MeSH
- Risk Factors MeSH
- Schizophrenia drug therapy therapy MeSH
- Triglycerides physiology MeSH
- Treatment Outcome MeSH
- Body Weight Changes MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Agranulocytosis etiology MeSH
- Clozapine administration & dosage adverse effects therapeutic use MeSH
- Drug Resistance MeSH
- Schizophrenia MeSH
- Publication type
- Review MeSH
- MeSH
- Depressive Disorder drug therapy MeSH
- Adult MeSH
- Clozapine therapeutic use MeSH
- Drug Resistance MeSH
- Humans MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
