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Clobazam for intractable pediatric epilepsy
R D Sheth1, G M Ronen, K J Goulden
1Department of Neurology and Pediatrics, West Virginia University, Morgantown 26506-9180, USA.
Insights
Clobazam add-on therapy helped 65% of children with refractory epilepsy achieve seizure reduction. However, behavioral side effects led to withdrawal in 35% of patients.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Refractory epilepsy affects many children, often with developmental delays.
- Existing treatments may not provide adequate seizure control.
Purpose of the Study:
- To evaluate the efficacy and tolerability of add-on clobazam therapy in children with refractory epilepsy.
- To assess the impact of clobazam on seizure frequency and identify potential side effects.
Main Methods:
- A 5-year observational study of 63 children with refractory epilepsy.
- Children received clobazam as add-on therapy, with follow-up ranging from 15 to 64 months.
- Dosage averaged 0.8 mg/kg daily.
Main Results:
- 65% of children experienced significant seizure reduction (41% seizure-free or >90% reduction, 24% with 50-90% reduction).
- 35% of patients discontinued clobazam due to side effects or tolerance.
- Reported side effects included behavioral issues (aggression, hyperactivity, depression) and insomnia.
Conclusions:
- Clobazam is a potentially effective add-on treatment for pediatric refractory epilepsy.
- Clinical utility can be limited by significant behavioral side effects in a subset of patients.
Abstract:
We report our experience with add-on clobazam therapy over a 5-year period in 63 children with refractory epilepsy. The mean duration of epilepsy was 6.7 years. Children were followed for 15 to 64 months. Of 63 children, 57 were developmentally delayed, and 54 had a symptomatic/cryptogenic epilepsy. Forty-one percent became either seizure free or had a greater than 90% reduction in seizure frequency. Seizure frequency was reduced 50% to 90% in another 24%. The average daily dose of clobazam was 0.8 mg/kg. Thirty-five percent had the medication withdrawn for persistent or unacceptable side effects or the development of tolerance (seven patients). Side effects included severe aggressive outbursts, hyperactivity, insomnia, and depression with suicidal ideation. Clobazam is a useful add-on medication for 65% of children with epilepsy. Clinical utility may be limited by behavioral side effects in some patients.