Tipik ve Atipik Antipsikotik İlaç Kullanımına Bağlı EEG Anormallikleri

Year 2016, , 97 - 104, 30.04.2016

Süreyya Ekem Nida Taşçılar Esra Acıman Demirel , Banu Özen Barut Handan Ankaralı , H. Atasoy

https://doi.org/10.21673/anadoluklin.180733

Abstract

Amaç: Tipik antipsikotikler ve klozapin EEG anormalliklerine ve epileptik nöbetlere neden olabilir.
Yeni kuşak antipsikotiklerin EEG üzerindeki etkileri çok fazla bilinmemektedir. Yapılan bu çalış-
mada klozapin, ketiapin, risperidon ve olanzapin gibi atipik antipsikotikler, amisülpirid, aripiprazol,
paliperidon gibi yeni diğer atipik antipsikotikler ve klorpromazin, haloperidol, zuklopentiksol,
pimozid gibi tipik antipsikotiklerin EEG anormallikleri üzerine etkileri araştırılmıştır.

Gereç ve Yöntemler: Şizofreni veya şizoaffektif bozukluk tanılı 102 hasta prospektif olarak de-
ğerlendirilerek EEG’leri çekildi. Bunların 82’si atipik [klozapin (n:16), risperidon (n:20), ketiapin
(n:10), olanzapin (n:14), diğer yeni atipik antipsikotikler (n:10)] ve tipik [haloperidol (n:5), klorpromazin
(n:2), zuklopentiksol (n:3), pimozid (n:2)] antipsikotik kullanıyordu, 20’si ise ilaç kullanmıyordu.
Bu üç alt grup; cinsiyet ve yaş uyumlu sağlıklı kontrol grubunun (n=29) EEG’leri ile
karşılaştırıldı.

Bulgular: Gruplar arasında demografik özellikler bakımından istatiksel olarak anlamlı fark saptanmadı.
Hem ilaç kullanmayan hastaların hem de sağlıklı kontrollerin EEG’leri normaldi. Klozapin
kullanan hastaların % 31,3’ünde (p < 0,05), ketiapin kullananların da %10’unda (p > 0,05) epileptik
aktivite gözlendi. Epileptik aktivite dışındaki EEG anormallikleri tipik antipsikotik kullananların
%58,3’ünde (p < 0,01), risperidon kullananlarında %35’inde (p < 0,01) saptandı. EEG ketiapin ve yeni
atipik antipsikotik kullananların %80’inde normalken, tipik antipsikotik kullananların %33,3’ünde
normaldi (p=0,012).

Tartışma ve Sonuç: Burada klozapinin en epileptojen antipsikotik olduğunu ve tipik antipsikotiklerin
EEG’yi en fazla bozduğunu bulduk. Ancak klozapin tedavisi alan psikotik hastalarda EEG
bir gerekliliktir. Epilepsinin eklendiği psikotik hastalara yeni atipik antipsikotikler verilebilir, çünkü
EEG üzerine en az istenmeyen etkiler bu ilaçlarla gözlenmiştir. Buna ilaveten antipsikotik ilaçlar
ve epilepsi eşiği arasındaki kompleks ilişkileri açığa çıkarmak için daha fazla bilimsel araştırmaya
ihtiyaç olduğunu da vurgulanmamız lazımdır.

Keywords

elektroensefalografi, tipik antipsikotikler, atipik antipsikotikler, epileptik aktivite

EEG Abnormalities Associated with the Use of Typical and Atypical Antipsychotics,

Abstract

Aim: Typical antipsychotics and clozapine could cause EEG abnormalities and risk of epileptic seizures. Little is known about the effects of newer antipsychotics on EEG. The present study therefore examined the risk of EEG abnormalities associated with the use of atypical antipsychotics [clozapine, quetiapine, risperidone, olanzapine and new atypical antipsychotics (amisulpride, aripiprazole, paliperidone)] and of the typical antipsychotics (chlorpromazine, haloperidol, zuclopenthixol, pimozide).

Materials and Methods: EEG patterns were prospectively investigated in 102 patients with schizophrenia or schizoaffective disorders. While 82 out of the 102 patients were under atypical [clozapine (n=16), risperidone (n=20), quetiapine (n=10), olanzapine (n=14), and new atypical antipsychotics (n=10)] and typical [haloperidol (n=5), chlorpromazine (n=2), zuclopenthixol (n=3), pimozide (n=2)] antipsychotic treatment, 20 of them were not under any treatment. These three groups were compared with a sex- and aged- matched control group of healthy volunteers(n=29).

Results: No statistically significant difference regarding demographic characteristics was found between the groups. Both the patients who were not on any medication and the healthy volunteers had normal EEG’s. Epileptic activity was observed in 31.3% of the patients under clozapine treatment (p<0.05) and in 10% of the patients under quetiapine treatment (p>0.05). EEG abnormalities other than epileptic activity were observed in 58.3% of the patients under typical antipsychotics (p<0.01) and 35% of the patients under risperidone treatment (p<0.01). EEG was normal in 78–80% of the patients using quetiapine and new atypical antipsychotics, compared to 33.3% of the patients under typical antipsychotic treatment (p=0.012). 

Discussion and Conclusion: Herein, we found that clozapine was the most epileptogenic antipsychotic and that typical antipsychoticswere making the worse EEG changes. Nevertheless, in the psychotic patients under clozapine treatment EEG is a must. Psychotic patients with consequential epilepsy could be given new atypical antipsychotics because it has the least unwanted effects on EEG. Moreover, it should also be emphasized that there is a need for further scientific research to clarify all aspects characterizing the complex link between seizure threshold and psychotropic drugs.

Keywords

electroencephalography, typical antipsychotics, atypical antipsychotics, epileptic activity

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