How does comorbid epilepsy influence your decision on antipsychotic medications?

In general, epilepsy is not a contraindication to the use of antipsychotic medications if they are needed despite the known risk of lowering the seizure threshold. In general, the risk of seizures for most antipsychotics is low, though some antipsychotics, such as clozapine, olanzapine, and quetiapine, have higher reported rates, while others, such as aripiprazole, are considered to have a lower risk (mostly at a case report level).

If considering antipsychotic medications in a patient with co-morbid epilepsy, it can be helpful to consider the following:

1. How well controlled is their epilepsy? This can include consideration of how difficult it was to gain adequate control of symptoms, how frequently they continue to have seizures, how easily ...

Carefully, to say the least.

A number of meds lower the seizure threshold.

It is important to ensure that anti-epileptics are at a therapeutic level.

Also have an EKG to see the rhythm, QTC, and conduction defects.