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Clobazam as Add-on Therapy for Temporal Lobe Epilepsy and Hippocampal Sclerosis

Published online by Cambridge University Press:  02 December 2014

Maria Augusta Montenegro ,
Claudio Meilman Ferreira ,
Fernando Cendes ,
Li M. Li  and
Carlos A.M. Guerreiro
Maria Augusta Montenegro
Affiliation:
Department of Neurology, University of Campinas / UNICAMP, Cidade Universitária Zeferino Vaz, SP, Brazil
Claudio Meilman Ferreira
Affiliation:
Department of Neurology, University of Campinas / UNICAMP, Cidade Universitária Zeferino Vaz, SP, Brazil
Fernando Cendes
Affiliation:
Department of Neurology, University of Campinas / UNICAMP, Cidade Universitária Zeferino Vaz, SP, Brazil
Li M. Li
Affiliation:
Department of Neurology, University of Campinas / UNICAMP, Cidade Universitária Zeferino Vaz, SP, Brazil
Carlos A.M. Guerreiro
Affiliation:
Department of Neurology, University of Campinas / UNICAMP, Cidade Universitária Zeferino Vaz, SP, Brazil
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Abstract

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Background:

Clobazam is a benzodiazepine with known antiepileptic action; however, it is not considered first line therapy in the treatment of epilepsy. The objective of this study was to evaluate the efficacy of clobazam as add-on therapy in adults with temporal lobe epilepsy associated with MRI evidence of hippocampal sclerosis (HS).

Method:

This is a retrospective study, conducted at our epilepsy clinic which evaluated clobazam as add-on therapy in patients with temporal lobe epilepsy and MRI signs of HS. Clobazam was prescribed based on the minimum effective dose up to the maximum tolerated dose.

Results:

Seventy-eight patients met the inclusion criteria (51 women), ages ranging from 16 to 76 years old (mean=42.2). Dosage of clobazam ranged from 5 to 60 mg/day (mean=22.6 mg/day). Clobazam was used from one month to eight years (mean=29 months). Sixteen (20.5%) patients were seizure-free, 20 (25.5%) had more than 75% improvement in seizure control, eight (10%) had more than 50% and 20 (26%) were non responders to clobazam. In 14 (18%) we could not determine seizure frequency during follow-up. The improvement in seizure control lasted for more than one year in 30 (68%) patients.

Conclusion:

Our data suggest that clobazam should be considered as add-on therapy in the treatment of patients with temporal lobe epilepsy associated with MRI signs of HS.

Résumé:

RÉSUMÉ:Introduction:

Le clobazam est une benzodiazépine qui a un effet antiépileptique. Cependant, cette substance n’est pas considérée comme un médicament de première ligne dans le traitement de l’épilepsie. L’objectif de cette étude était d’évaluer l’efficacité du clobazam comme traitement adjuvant chez les adultes souffrant d’épilepsie temporale et ayant une sclérose de l’hippocampe (SH) à l’IRM.

Méthode:

Il s’agit d’une étude rétrospective menée à la clinique d’épilepsie de notre hôpital universitaire. Nous avons évalué les patients recevant du clobazam comme traitement adjuvant parmi un groupe de 100 patients consécutifs souffrant d’épilepsie temporale et ayant des signes de SH à l’IRM. La dose de clobazam prescrite variait de la dose minimale efficace à la dose maximale tolérée.

Résultats:

78 patients (51 femmes et 27 hommes), dont l’âge variait de 16 à 76 ans (âge moyen 42,2 ans) rencontraient les critères d’admission dans l’étude. Le dosage du clobazam était de 5 à 60 mg/j (dose moyenne de 22,6 mg/j). La durée du traitement était de 1 mois à 8 ans (durée moyenne 29 mois). Seize patients (20,5%) n’avaient plus de crises, 20 (25,5%) avaient une amélioration de plus de 75% dans le contrôle des crises, 8 (10%) avaient une amélioration de plus de 50% et 20 (26%) étaient des non–répondeurs. Chez 14 (18%), la fréquence des crises pendant le suivi n’a pu être déterminée. L’amélioration dans le contrôle des crises a duré plus d’un an chez 30 patients (68%).

Conclusion:

Selon ces données, le clobazam est sûr et efficace dans le traitement de patients ayant une épilepsie temporale et des signes de SH à l’IRM.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 1 , February 2005 , pp. 93 - 96
Copyright
Copyright © The Canadian Journal of Neurological 2014

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