Clozapine-Induced Microseizures, Orofacial Dyskinesia, andSpeech Dysfluency in an Adolescent with Treatment ResistantEarly Onset Schizophrenia on Concurrent Lithium Therapy

Clozapine is an atypical antipsychotic used in the treatment of refractory schizophrenia. It has a well-known side effect profile,including agranulocytosis, decreased seizure threshold, and tardive dyskinesia. In addition, numerous case reports have describedclozapine-induced stuttering in adults. However, there has been only one previous case report describing it in the adolescentpopulation. In addition, concurrent lithium therapy has been shown to enhance the neurotoxic effects of antipsychotics and lowerthe seizure threshold. Here, we report on the development of clozapine-induced microseizures, orofacial dyskinesia, and stutteringin a 17-year-old adolescent male with treatment of refractory early onset schizophrenia on clozapine and concurrent lithium therapy.The patient’s symptoms of schizophrenia responded well to the clozapine regimen. However, with the escalating dose of clozapine,the patient developed speech dysfluency in the form of stuttering and perioral twitching. An electroencephalogram confirmedseizure activity. Due to similarities with tardive dyskinesia, symptoms of microseizures induced by atypical antipsychotics maynot be accurately diagnosed. A multidisciplinary treatment of speech dysfluency is of particular importance in the adolescentschizophrenic patients, who are expected to have longer duration of lifetime exposure to antipsychotics and in whom peer groupinteraction is crucial for normal personal and social development.