A 22-year-old, right handed male with premorbid schizoid traits without significant past or family history of mental illness presented with an insidious onset, gradually progressive continuous course of four years duration of disabling symptoms characterized by delusion of control, delusion of persecution, auditory hallucinations (commenting and commanding type), anger outbursts and violent behaviour, mannerism, regressed behaviour, social withdrawal, poor personal care, decreased sleep, and appetite associated with severe socio-occupational dysfunction. There was no history of other Schneiderian First Rank Symptoms, substance use or abuse, suicidal attempt or ideations, affective symptoms, head injury, learning disability, epilepsy or neurodegenerative disorder. He was treated with adequate trial of trifluperazine, chlorpromazine, risperidone, olanzapine and aripiprazole since last three years with electroconvulsive therapy cycles (12 effective ECT's). Clozapine could not be built-up because he had persistent history of development of agranulocytosis even with 25 mg initiation (Total Leukocyte count was 2500/cc mm) and associated anemia (Hemoglobin 7.2 gm%). He was prescribed zotepine 50 mg per day, which was gradually increased every week by 50 mg, till 350 mg per day. His liver function tests were monitored for transaminase levels and were found to be within normal limits. He showed moderate improvement in the psychotic symptoms by week 8 (PANSS score in all three dimensions showed significant change from baseline by week 8). The dose was raised from 300 to 350 mg per day (in view of residual auditory hallucinations and off and on anger outbursts against parents). On 49th day on zotepine he developed paroxysms of sudden, brief and jerky muscle contractions involving right more than left upper extremities followed by tonic contraction of muscles throughout the body that typically continued for 20-30 seconds followed by clonic phase which had lasted for about a minute. He was found to be in a state of flaccid, unresponsiveness with stridorous breathing and involuntary passage of urine. He was given injection diazepam slow intravenous drip and his airway was secured. The EEG showed paroxysms of repetitive, generalized high amplitude discharges associated with muscle artefact followed by slow spikes [Figure 1]. The dose of zotepine was reduced to 300 mg per day. For the next week he remained seizure free and the EEG was showed residual epileptiform activity. However he began complaining of hearing of third person voices; which were not present with higher dose of zotepine. He was re-hospitalized for a brief duration and the dose of zotepine was again increased to 350 mg/day, four hours later patient again suffered another episode of myoclonic jerks; followed by tonic-clonic convulsions and post-ictal confusion. The EEG concomitantly showed generalized, transient, repetitive paroxysms of high amplitude spikes and polyspikes followed by slow waves. The dose of zotepine was reduced to 300 mg per day and clobazam 20 mg per day was added. Distraction techniques along with cognitive remediation were taught to patient to deal with intractable auditory hallucination. Patient has been seizure free since last four months and clinically better in both positive and negative symptoms.