Toru Horinouchi, Mayusa Mito, Toshiyuki Ishikawa, Yuichi Nakamura, Shuhei Ishikawa, Naoki Hashimoto
Background: Treatment-resistant schizophrenia (TRS) poses a substantial clinical challenge for which clozapine (CLOZ) is the only effective treatment. However, clinicians may hesitate to prescribe CLOZ for TRS patients with epilepsy due to its presence because CLOZ is contraindicated in patients with uncontrolled epilepsy in some countries including Japan. Case Presentation: A 36-year-old male with TRS and focal epilepsy underwent CLOZ therapy. CLOZ was initiated at 6.25 mg and gradually titrated to 250 mg over 3 months, achieving a plasma concentration of 449 ng/mL. Psychotic symptoms improved without worsening of seizure frequency or severity. Mild side effects such as drowsiness and drooling were manageable. Long-term video electroencephalography monitoring detected spike-and-wave activity centered in the frontal region, but did not detect any overt epileptic seizures. Conclusion: We report a case of TRS with comorbid epilepsy in which CLOZ therapy was both effective and safe.