Treatment of febrile seizures with intermittent clobazam

Abstract

-Fifty children, 24 female and 26 male, with ages varying from 6 to 72 months (mean=23.7 m.) that experienced at least one febrile seizure (FS) entered a prospective study of intermittent therapy with clobazam. Cases with severe neurological abnormalities, progressive neurological disease, afebrile seizures, symptomatic seizures of other nature, or seizures during a central nervous system infection were excluded. Seizures were of the simple type in 25 patients, complex in 20 and unclassified in 5. The mean follow-up period was 7.9 months (range=l to 23 m.), and the age at the first seizure varied from 5 to 42 months (mean=16.8 m.). Clobazam was administered orally during the febrile episode according to the child's weight: up to 5 kg, 5 mg/day; from 5 to 10 kg, 10 mg/day; from 11 to 15 kg, 15 mg/day, and over 15 kg, 20 mg/day. There were 219 febrile episodes, with temperature above 37.8 °C, in 40 children during the study period. Twelve children never received clobazam and 28 received the drug at least once. Drug efficacy was measured by comparing FS recurrence in the febrile episodes that were treated with clobazam with those in which only antipyretic measures were taken. Ten children (20%) experienced a FS during the study period. Of the 171 febrile episodes treated with clobazam there were only 3 recurrences (1.7%), while of the 48 episodes treated only with antipyretic measures there were 11 recurrences (22.9%), a difference highly significant (p<0.0001). Adverse effects occurred in 10/28 patients (35.7%), consisting mainly in vomiting, somnolence and hyperactivity. Only one patient had recurrent vomiting which lead to drug interruption. These effects did not necessarily occurred in every instance the drug was administered, being present in one febrile episode and not in the others. We conclude that clonazepam is safe and efficacious in preventing FS recurrence. It may be an alternative to diazepam in the intermittent treatment of FS recurrence.KEY WORDS: febrile seizures, clobazam, antiepileptic drugs. Tratamento de convuslsões febris com clobazam intermitenteRESUMO -Avaliamos prospectivamente o uso intermitente do clobazam na profilaxia de convulsão febril em 50 crianças, 24 do sexo feminino e 26 do masculino, com idades entre 6 e 72 meses (média = 23,7 meses) que haviam apresentado pelo menos um episódio de convulsão febril. Foram excluídas crianças com anormalidades neurológicas severas, doença neurológica progressiva, crises durante infecção do SNC e crises epilépticas sintomáticas outras. As convulsões febris foram classificadas como simples em 25 crianças, complicadas em 20 e em 5 crianças não foi possível a classificação. O tempo médio de seguimento foi 7,9 meses (1-23 meses) e a idade, na primeira crise, variou de 5 a 42 meses (média = 16,8 meses). O clobazam foi administrado por via oral, durante os episódios febris, na dose de 5 mg/dia, em crianças até 5 kg; 10 mg/dia, de 5-10 kg; 15 mg/dia, de 11 -15 kg, e 20 mg/dia, acima de 20 kg. Quarenta crianças apresentaram febre (T > 37,8 °C), num...

Diazepam Versus Clobazam for Intermittent Prophylaxis of Febrile Seizures

“…Recurrence rate was 1.7% in the clobazam group and 22.9% in patients who received only antipyretic (P<0.0001) [13].…”

Clobazam is a Better Option for Intermittent Prophylaxis of Febrile Convulsion

“…Some studies have compared clobazam against placebo as prophylaxis for febrile convulsion and there are few studies comparing diazepam with clobazam in this regard 4,12,[15][16] . Bajaj, in a double blind placebo-controlled study reported that recurrence of febrile convulsion was observed in 30% patients in the clobazam group vs 83.3% in the placebo group.…”

“…Bajaj, in a double blind placebo-controlled study reported that recurrence of febrile convulsion was observed in 30% patients in the clobazam group vs 83.3% in the placebo group. They concluded that clobazam is efficacious and well tolerated as intermittent prophylaxis of febrile convulsion and is superior to the use of intermittent antipyretics alone 15 . Manresa performed a study on 50 children with febrile seizures and found that clobazam is an effective prophylaxis for febrile convulsion.…”

Atualização no diagnóstico e tratamento das crises epilépticas febris

“…The following weightbased dosages can be prescribed: 5 mg/day in children 5 kg or under; 10 mg/day in children 5 to 10 kg; 15 mg/day in children 11 to 15 kg; and 20 mg/day in children weighing 15 kg or more. 24 . Oral diazepam 0.5 to 1 mg/kg/day in two divided doses has also been assessed in Brazilian studies.…”