Short burst Clobazam dosing at discharge from VEEG evaluation reduces re-presentation with seizures

Recurrent seizures and status epilepticus after medication reduction for inpatient Video Electroencephalograph (VEEG) monitoring is a well-known complication of this investigation. In the literature this is reported to occur at a rate of approximately 3-7%. We review the use of short burst Clobazam dosing on discharge from the Epilepsy monitoring unit (EMU) to determine if this might reduce rates of representation with seizures.

We performed a retrospective review of all cases admitted to the EMU. Their medication reduction, number of seizures, seizure severity and demographics were collected. Representations to hospital were considered if they occurred within 14 days of discharge from the unit.

264 cases were included, and 146 patients received 5 days of Clobazam 10 mg PO BD upon discharge after VEEG and 118 did not. There were significantly fewer patients re-presenting to hospital for seizures in the 14 days following discharge in those who were administered short-burst Clobazam compared to those who were not (0% and 4.23% respectively). There was also a trend towards fewer re-admissions for non-seizure indications including mental health issues or non-epileptic seizures and AED side effects. There were no definite adverse reactions to Clobazam recorded.

Short burst Clobazam appears to be a safe and effective means to reduce representation with seizures after medication reduction during VEEG recording. This obviously benefits patients but it may also be a cost-effective means to reduce unnecessary health expenditure.