Abstract
A 38-year-old patient with severe obsessive-compulsive disorder received fluvoxamine
in a clinical study. Psychometric ratings showed marked clinical improvement in the
third week of fluvoxamine administration, but after 8 weeks, at a dose of 300 mg per
day, he suffered a grand mal seizure after drinking a glass of beer (0.2 liter). He
had no history of previous epileptic seizures. Careful neurological evaluation including
computer tomography and magnetic resonance imaging of the brain revealed no signs
of acute disease. EEC before the fit did not show epileptiform activity; after the
fit, spikes and spike-wave complexes appeared, which disappeared upon discontinuation
of fluvoxamine. Since his obsessive-compulsive symptoms had responded well to fluvoxamine
and worsened after its discontinuation, the drug was cautiously reintroduced. Improvement
of the obsessive-compulsive symptoms was observed again, but spikes and spike-wave
complexes reappeared at a dose of 50 mg per day. Under anticonvulsant treatment with
carbamazepine, fluvoxamine was increased to 100 mg per day. No seizures occurred during
a follow-up to two years.
