Oral flumazenil in the treatment of epilepsy

Flumazenil does not decrease the antiepileptic effect of diazepam when administered concomitantly, and probably has intrinsic antiepileptic properties. It appears that it can be added safely to diazepam therapy over an extended period, though it is unknown whether the combination is better than benzodiazepines alone. As no serious adverse effects have been noted, flumazenil may be tried in benzodiazepine-tolerant patients. Although reversal of tolerance has not been demonstrated clearly, flumazenil is not likely to decrease the efficacy of the benzodiazepines. Patients unresponsive to conventional antiepileptics, including those with generalized seizures, may benefit from adjunctive flumazenil therapy. Previously untreated patients should be given benzodiazepines or other standard therapy until more studies are performed. Currently, no adequately designed long-term trials have been conducted on treatment of epilepsy using flumazenil, rendering evaluation of its use as a single-agent antiepileptic difficult. Without such controlled studies, flumazenil's effects in the clinical setting can only be speculated.