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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

References

1. Karceski, S, Morrell, M, Carpenter, D. The expert consensus guidelineseries. Treatment of epilepsy. Epilepsy Behav 2001;2: A1-A50.Google Scholar
2. Brodie, MJ, Dichter, MA. Drug therapy: antiepileptic drugs. N Engl J Med 1996;334:168–175.Google Scholar
3. Wiebe, S, Blume, WT, Girvin, JP, Eliasziw, M. Effectiveness andefficiency of surgery for temporal lobe epilepsy study group. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 2001;345:311–318.CrossRefGoogle Scholar
4. Engel, J Jr. Finally, a randomized, controlled trial of epilepsysurgery. N Engl J Med 2001;354:365–367.Google Scholar
5. Barcs, G, Halasz, P. Effectiveness and tolerance of clobazam intemporal lobe epilepsy. Acta Neurol Scand 1996;93:88–93.CrossRefGoogle Scholar
6. Heller, AJ, Ring, HA, Reynolds, H-M. Factors relating to dramaticresponse to clobazam in refractory epilepsy. Epilepsy Res 1998; 2:276–280.CrossRefGoogle Scholar
7. Montenegro, MA, Cendes, F, Noronha, AL, et al. Efficacy ofclobazam as add-on therapy in patients with refractory partialepilepsy. Epilepsia 2001;42:539–542.Google Scholar
8. Canadian Clobazam Cooperative Group. Clobazam in treatment ofrefractory epilepsy: the Canadian experience. A retrospectivestudy. Epilepsia 1991;32:407–416.Google Scholar
9. Keene, DL, Whiting, S, Humphreys, P. Clobazam as an add-on drugin the treatment of refractory epilepsy of childhood. Can J Neurol Sci 1990;17:317–319.Google Scholar
10. Koeppen, D, Baruzzi, A, Capozza, M, et al. Clobazam in therapy-resistant patients with partial epilepsy: a double-blind placebo-controlled crossover study. Epilepsia 1987;28:495–506.CrossRefGoogle ScholarPubMed
11. Robertson, MM. The place of clobazam in the treatment of epilepsy:an update. Hum Psychopharmacol 1995;10:S43-S63.Google Scholar
12. Satishchandra, P, Varadarajalu, R, Rajaram, P. Long-term use ofclobazam in the management of intractable epilepsy: a prospective study. Neurology (India) 1998;46:284–287.Google ScholarPubMed
13. Schmidt, D, Rohde, M, Wolf, P, Roeder-Wanner, U. Clobazam forrefractory focal epilepsy. A controlled trial. Arch Neurol 1986; 43:824–826.CrossRefGoogle ScholarPubMed
14. Canadian Study Group for Childhood Epilepsy. Clobazam hasequivalent efficacy to carbamazepine and phenytoin as monotherapy for childhood epilepsy. Epilepsia 1998;39:952–959.CrossRefGoogle Scholar
15. Commission on Classification and Terminology of the InternationalLeague Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989;30:389–399.CrossRefGoogle Scholar
16. Kwan, P, Brodie, MJ. Early identification of refractory epilepsy. N Engl J Med 2000;342:314–319.Google Scholar
17. Kobayashi, E, Li, LM, Lopes-Cendes, I, Cendes, F. Magneticresonance imaging evidence of hippocampal sclerosis in asymptomatic, first-degree relatives of patients with familial mesial temporal lobe epilepsy. Arch Neurol 2002;59:1891–1894.Google Scholar
18. Kobayashi, E, Lopes-Cendes, I, Guerreiro, CA, et al. Seizure outcomeand hippocampal atrophy in familial mesial temporal lobe epilepsy. Neurology 2001;56:166–172.CrossRefGoogle Scholar
19. Andrade-Valença, LP, Valença, MM, Ribeiro, LT, et al. Clinical andneuroimaging features of good and poor seizure control in patients with mesial temporal lobe epilepsy and hippocampal atrophy. Epilepsia 2003;44:807–814.Google Scholar
20. Semah, F, Picot, MC, Adam, C, et al. Is the underlying cause ofepilepsy a major prognostic factor for recurrence? Neurology 1998;51:1256–1262.Google Scholar
21. Stephen, LJ, Kwan, P, Brodie, MJ. Does the cause of localization-related epilepsy influence the response to antiepileptic drugtreatment? Epilepsia 2001;42(3):357–362.CrossRefGoogle Scholar
22. Kim, W-J, Park, S-C, Lee, S-J, et al. The prognosis for control ofseizures with medication in patients with MRI evidence for mesial temporal sclerosis. Epilepsia 1999;40(3):290–293.CrossRefGoogle ScholarPubMed
23. Perucca, E. Drug Treatment. In: Shorvon, S, Dreifuss, F, Fish, D, Thomas, D (Eds). The Treatment of Epilepsy. London: Blackwell Science, 1996:152–168.Google Scholar
24. Meinardi, H. Why phenobarbital? Epicaded News 1993;1:7–8.Google Scholar
25. Schmidt, D. Drug Trials in Epilepsy. A Physicians Guide. London: Martin Dunite, 1998.Google Scholar
26. Singh, A, Guberman, AH, Boisvert, D. Clobazam as long-termepilepsy treatment: sustained responders versus those developingtolerance. Epilepsia 1995;36:798–803.Google Scholar
27. Shorvon, SD. Benzodiazepines. Clobazam. In: Levy, RH, Mattson, RH, Meldrum, BS, (Eds). Antiepileptic Drugs. 4th ed. New York: Raven Press Ltd., 1995:763–777.Google Scholar
28. Satishchandra, P, Trimble, MR. On being seizure-free. Epilepsy Behav 2001;2:4–7.Google Scholar