Improvement in Quality of Seizures in Electroconvulsive Therapy With Zotepine: A Case Report

Regular symmetric high-amplitude seizure waves, postictal suppression, constant seizure duration, and sympathetic nervous system excitation are used to evaluate the efficacy of electroconvulsive therapy (ECT) for seizures. Seizure quality is rated from 0 to 3 (higher scores indicate better quality) using seizure quality categories (SQC). We report a case in which zotepine (ZTP) improved seizure quality. A woman in her 50s developed schizophrenia in 1993. In December 2021, her delusions, anxiety, and agitation worsened, and she was admitted to our hospital. ECT was started in November 2022 but discontinued after 10 sessions because of the patient's refusal. However, her agitation became more noticeable, and she was placed in isolation in December 2022. ECT was resumed in March 2023 and accompanied by risperidone (RIS) 4 mg, with SQC scores of 1-2 points for sessions 1-8. A gradual change from RIS to ZTP began at session 9, and RIS was discontinued by session 17. The SQC was 2 points with ZTP dose of 150 mg. The SQC improved to 3 points during sessions 21-23 after ZTP dose was increased to 300 mg. The electroencephalogram showed improvement, especially in regular symmetric high-amplitude seizure waves and postictal suppression during sessions 21-23. ECT was terminated in September 2023 (after 27 sessions in total) when the patient was mentally ready to be released from isolation. This case indicates that ZTP may improve the quality of ECT-induced seizures.