Benzodiazepines are commonly prescribed as anxiolytics, sedatives, and anticonvulsants. They act on the GABAA receptor by increasing the conductance chloride through ionic channels, promoting a state of central nervous system depression. The clinical properties of benzodiazepines are dependent upon the composition of the different subunits of the GABAA receptor. Each subunit, in turn, has multiple subtypes that are present throughout the central nervous system, all of which impart different clinical responses. Benzodiazepines are the first-line treatment of status epilepticus. Time to treatment is crucial, and clinical response to benzodiazepines is lost with prolonged status epilepticus. Non-intravenous routes of midazolam should be considered as an equally efficacious alternative to intravenous lorazepam, which is the most commonly administered benzodiazepine for status epilepticus when intravenous access is available. Outpatient therapy with benzodiazepines for the acute treatment of seizures is currently limited to rectal diazepam, but alternative routes of administration are under development. Clobazam and clonazepam are good options for seizure prophylaxis in patients with epilepsy refractory to multiple antiepileptic drugs. Clobazam is preferred due to its affinity for the α2 subunit of the GABAA receptor, which leads to less potential for sedation. Adverse effects of chronic benzodiazepine use are sedation, tolerance, and potential for addiction and misuse in some patients.
This small study suggests that an interactive format using Web technology enhances learning about seizure disorders, perhaps by stimulation of critical thinking and promoting greater student motivation.
Drug initiation after a first seizure decreases early seizure recurrence, but does not affect the long-term prognosis of developing epilepsy. Medication withdrawal after a period of seizure remission increases the risk of relapse, but the benefits of successful AED discontinuation may be substantial. In the end, the decision of whether to initiate treatment after a single seizure and whether to withdraw AED therapy in patients enjoying a prolonged period of seizure freedom should be made on an individual case basis, which balances the risk of seizure relapse and subsequent disability against the likely impact of medication-related physical, cognitive, and psychologic adverse effects.
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