paliperidone-palmitate and Seizures

Catatonia is a neuropsychiatric syndrome involving motor signs in association with disorders of mood, behavior, or thought. Bitemporal electrode placement electroconvulsive therapy (ECT) is a proven effective treatment for catatonia, and this mode of ECT delivery is the preferred method of treatment in this condition. Studies in major depressive disorder have demonstrated that suprathreshold, nondominant (right) hemisphere, unilateral electrode placement ECT has fewer adverse effects, especially cognitive adverse effects, than bitemporal ECT. This case series describes the use of right unilateral (RUL) ECT in 5 patients with catatonia. Before ECT, all 5 patients in this series initially failed therapy with benzodiazepines and psychotropic medications. Each catatonic patient received a series of 8 to 12 RUL ECT in an every-other-day series. After ECT, 4 of the 5 patients had a full recovery from catatonia. One patient achieved only partial response to RUL ECT, and no additional benefit was obtained with bitemporal ECT. All patients in this case series tolerated RUL ECT without major adverse effects. This case series illustrates successful use of RUL ECT in patients with catatonia and adds to the early literature demonstrating its effective use in treating this complex condition.

Topics: Adolescent; Adult; Aged, 80 and over; Antipsychotic Agents; Bipolar Disorder; Catatonia; Depressive Disorder, Major; Electroconvulsive Therapy; Female; GABA Modulators; Humans; Isoxazoles; Lorazepam; Lupus Erythematosus, Systemic; Male; Paliperidone Palmitate; Psychotic Disorders; Pyrimidines; Schizophrenia, Catatonic; Seizures; Treatment Outcome; Young Adult

Topics: Adult; Humans; Isoxazoles; Male; Paliperidone Palmitate; Pyrimidines; Seizures; Valproic Acid

A case of apparent seizure and atrial fibrillation associated with paliperidone is reported.. A 46-year-old man arrived at the emergency room (ER) via ambulance. Earlier that morning, his wife observed him awakening in a panic, drifting back to sleep, and then subsequently awakening in a panic with an apparent seizure lasting one to two minutes. The episode included tongue biting and urinary incontinence. His medical history included bipolar disorder, diabetes mellitus, hyperlipidemia, and hypertension. The patient's medications included metformin, insulin glargine, insulin lispro, simvastatin, enalapril, escitalopram, lamotrigine, and clonazepam and had not changed for many months except for the recent addition of paliperidone four days before his arrival at the ER. Electrocardiography revealed atrial fibrillation, a ventricular rate of 151 beats/min, a Q-Tc interval of 461 msec, and no significant changes in the ST segment or T wave. He had no chest pain, and all other laboratory test results and vital signs were normal. The patient was admitted for evaluation and given a single oral dose of potassium chloride. Diltiazem i.v. was administered with resultant conversion to normal sinus rhythm, after which the patient's heart rate and Q-Tc interval normalized. The patient was discharged after one day.. A man taking paliperidone and multiple other drugs experienced atrial fibrillation and a possible seizure. Although these are known adverse effects of atypical antipsychotics, it is unusual to have both events occur concurrently and with low-to-average dosages, and these events have not been associated with paliperidone in published case reports.

Topics: Antipsychotic Agents; Atrial Fibrillation; Bipolar Disorder; Humans; Isoxazoles; Male; Middle Aged; Paliperidone Palmitate; Pyrimidines; Seizures