Does Quetiapine (Seroquel) increase the risk of seizure?

From the Guidelines

Quetiapine (Seroquel) can slightly increase the risk of seizures, particularly at higher doses, with a risk of about 0.1-0.2% of patients taking the medication. This risk is dose-dependent, meaning higher doses carry greater risk, and patients with a history of seizures, brain injury, or other neurological conditions may be at increased risk 1. The mechanism likely involves the drug's effect on brain neurotransmitters, particularly dopamine and serotonin, which can lower the seizure threshold. Some key points to consider when evaluating the risk of seizures with quetiapine include:

• The risk of seizures is higher than the background rate in the general population
• Patients with a history of seizures or other neurological conditions may be at increased risk
• The seizure risk with quetiapine is lower than with some other antipsychotics like clozapine
• Regular monitoring may be necessary if you have risk factors, and your doctor should be informed about any history of seizures before starting this medication. It's also worth noting that while the evidence is not directly related to the question of quetiapine and seizure risk, the study from 1 discusses the potential for seizures as a side effect of SSRIs, highlighting the importance of considering seizure risk when prescribing medications that affect brain neurotransmitters.

From the FDA Drug Label

5.13 Seizures During clinical trials, seizures occurred in 0.5% (20/3490) of patients treated with quetiapine compared to 0.2% (2/954) on placebo and 0. 7% (4/527) on active control drugs. As with other antipsychotics, quetiapine should be used cautiously in patients with a history of seizures or with conditions that potentially lower the seizure threshold, e.g., Alzheimer’s dementia. Conditions that lower the seizure threshold may be more prevalent in a population of 65 years or older.

Seizure Risk with Quetiapine:

• The incidence of seizures in patients treated with quetiapine was 0.5% compared to 0.2% on placebo.
• Quetiapine should be used cautiously in patients with a history of seizures or conditions that lower the seizure threshold.
• The drug label suggests that quetiapine may increase the risk of seizures in certain patients, particularly those with a history of seizures or conditions that lower the seizure threshold 2.

From the Research

Seraquel and Seizure Risk

• The relationship between seraquel (quetiapine) and seizure risk is complex, with some studies suggesting a possible increased risk 3, 4.
• A case study reported a patient with Alzheimer's disease who experienced seizures while taking quetiapine, and the seizures ceased after the medication was stopped 3.
• Another study found that antipsychotic drugs, including quetiapine, can increase the risk of epileptic seizures, particularly at high doses or in patients with conditions that lower the seizure threshold 4.
• However, a study on the impact of neuroleptic medication on seizure threshold and duration in electroconvulsive therapy found that quetiapine actually reduced seizure activity 5.
• A systematic literature review on quetiapine safety in older adults did not specifically address the risk of seizures, but reported that the most commonly reported adverse events were somnolence, dizziness, headache, postural hypotension, and weight gain 6.
• A naturalistic study on the long-term treatment of bipolar disorder with quetiapine and classical mood stabilizers did not mention seizure risk as a significant concern 7.

Key Findings

• Quetiapine may increase the risk of seizures, particularly at high doses or in patients with conditions that lower the seizure threshold 3, 4.
• Quetiapine can reduce seizure activity in certain contexts, such as electroconvulsive therapy 5.
• The overall risk of seizures associated with quetiapine is not well established and may depend on various factors, including dose, patient population, and concomitant medications 3, 4, 5, 6, 7.