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Intermittent clobazam prophylaxis in hot water epilepsy is safe and effective: a prospective study
P Satishchandra1, S Dilipkumar1, D K Subbakrishna2
1Department of Neurology, National Institute of Mental Health and NeuroSciences [NIMHANS], Bangalore, India.
Purpose:
To evaluate the role of intermittent prophylaxis with clobazam in the management of HWE in a long-term prospective study.
Material And Methods:
Two hundred and sixty patients [M:F - 194:66] with HWE were recruited. Patients were divided into: (a) 'HWE alone' (n=198) - received intermittent clobazam prophylaxis, 1-1½h prior to hot water head bath (group A); (b) 62 patients (20.4%) with 'HWE with spontaneous seizures were treated with continuous AEDs along with intermittent clobazam therapy (group B).
Results:
Patients (n=198) in group A was followed for mean of 17.6 ± 10.6 months (range: 3-57). One hundred and forty seven patients (74.2%) had excellent response with complete seizure freedom with clobazam therapy while 12 (6.1%) had >75% reduction in seizure frequency. Remaining 39 (19.7%) required additional standard AED along with clobazam and 18 patients among them developed spontaneous/unprovoked seizure at follow up of 6.7 ± 4.1 months. Forty five patients in group B were seizure free while on continuous AEDs.
Conclusions:
Intermittent clobazam prophylaxis prior to head water bath might be a preferred mode of treatment of pure HWE. Additional AEDs are required if they have associated non-reflex unprovoked seizure.
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