A New Anticonvulsant in the Management of Minor Motor Seizures

Hanson, Rebecca A.; Menkes, John H.

doi:10.1111/j.1469-8749.1972.tb02549.x

Cited by 42 publications

(5 citation statements)

References 12 publications

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“…In less severe cases or in the absence of intravenous access, oral benzodiazepines may provide adequate sedation. In these cases, clonazepam was widely used in our experience, because of its good bioavailability, its brief onset of action (ranging from 20–40min), and the lack of significant active metabolites accumulation . Owing to its longer half‐life, diazepam was employed to obtain a more prolonged sedation, which is particularly useful in ensuring regular sleep intervals during the hyperkinetic status.…”

Section: Discussionmentioning

confidence: 99%

“…In these cases, clonazepam was widely used in our experience, because of its good bioavailability, its brief onset of action (ranging from 20-40min), and the lack of significant active metabolites accumulation. 11 Owing to its longer half-life, 12 diazepam was employed to obtain a more prolonged sedation, which is particularly useful in ensuring regular sleep intervals during the hyperkinetic status. Usually, benzodiazepines are well tolerated in children and can also be effective in long-term dystonia management.…”

Section: Discussionmentioning

confidence: 99%

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Prestatus and status dystonicus in children and adolescents

Garone

Graziola

Nicita

et al. 2019

Develop Med Child Neuro

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Aim To critically analyse the management of status dystonicus and prestatus dystonicus in children and adolescents, in order to examine clinical features, acute management, and risk of relapse in a paediatric cohort. Method Clinical, demographic, and therapeutic features were analysed according to disease severity. Risk of subsequent relapse was estimated through Kaplan–Meier curves. Results Thirty‐four patients (eight females, 26 males) experiencing 63 episodes of acute dystonia exacerbations at a tertiary referral Italian hospital were identified. Mean age at status dystonicus presentation was 9 years 11 months (11y at inclusion in the study). Onset of dystonia dated back to infancy in most cases. Fourteen patients experienced two or more episodes. Infections were the most common trigger (48%). Benzodiazepines were the most commonly used drugs for acute management. Stereotactic pallidotomy was performed in six cases during status dystonicus, and in two additional patients it was electively performed after medical management. The probability of survival free from status dystonicus relapses was 78% after 4 months and 61% after 27 months. Interpretation Dystonia exacerbations are potentially life‐threating emergencies, with a considerable risk of relapse. Nevertheless, no obvious factors for relapse risk stratification exist. Pallidotomy is a feasible option in medical refractory status dystonicus for patients with limited deep brain stimulation applicability, but the risk of recurrence is elevated. What this paper adds Acute exacerbations may affect up to 10% of children with dystonia. Infections are the most common precipitant factor. In about 30% of the cases, intensive care unit admission is needed. Subsequent relapses are common, reaching 25% risk at 1 year. Pallidotomy can be considered in medical‐refractory cases with no deep brain stimulation applicability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prestatus and status dystonicus in children and adolescents

Garone

Graziola

Nicita

et al. 2019

Develop Med Child Neuro

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“…One of the earliest nonsteroid treatments for infantile spasms were the benzodiazepines (41) but are only occasionally successful. Clonazepam and nitrazepam both have anecdotal evidence of efficacy (42,43).…”

Section: Treatmentmentioning

confidence: 99%

Infantile Spasms: Little Seizures, BIG Consequences

2006

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Infantile spasms is one of the “catastrophic childhood epilepsies” because of the difficulty in controlling seizures and the association with mental retardation. However, early recognition, a careful diagnostic evaluation, and proper treatment may allow some children to attain seizure control and to achieve a normal, or at least much improved, level of development. Thus, there is the opportunity to have an important impact in the lives of these unfortunate children and their families.

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“…Previous literature has suggested that tolerance to benzodiazepines may develop anytime from after a few days of treatment 23 to 18 months of long-term therapy, 24 with the majority of reports indicating that tolerance developed within 1 to 6 months of continuous benzodiazepine therapy. In the present analysis, seizure rates were consistent for groups on the basis of responder categories and baseline seizure quartiles, indicating no loss of response over 2 years of clobazam treatment.…”

Section: Discussionmentioning

confidence: 99%

Deconstructing tolerance with clobazam

et al. 2016

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Objective:To evaluate potential development of tolerance to adjunctive clobazam in patients with Lennox-Gastaut syndrome.Methods:Eligible patients enrolled in open-label extension study OV-1004, which continued until clobazam was commercially available in the United States or for a maximum of 2 years outside the United States. Enrolled patients started at 0.5 mg·kg−1·d−1 clobazam, not to exceed 40 mg/d. After 48 hours, dosages could be adjusted up to 2.0 mg·kg−1·d−1 (maximum 80 mg/d) on the basis of efficacy and tolerability. Post hoc analyses evaluated mean dosages and drop-seizure rates for the first 2 years of the open-label extension based on responder categories and baseline seizure quartiles in OV-1012. Individual patient listings were reviewed for dosage increases ≥40% and increasing seizure rates.Results:Data from 200 patients were included. For patients free of drop seizures, there was no notable change in dosage over 24 months. For responder groups still exhibiting drop seizures, dosages were increased. Weekly drop-seizure rates for 100% and ≥75% responders demonstrated a consistent response over time. Few patients had a dosage increase ≥40% associated with an increase in seizure rates.Conclusions:Two-year findings suggest that the majority of patients do not develop tolerance to the antiseizure actions of clobazam. Observed dosage increases may reflect best efforts to achieve seizure freedom. It is possible that the clinical development of tolerance to clobazam has been overstated.ClinicalTrials.gov identifier:NCT00518713 and NCT01160770.Classification of evidence:This study provides Class III evidence that the majority of patients do not develop tolerance to clobazam over 2 years of treatment.

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A New Anticonvulsant in the Management of Minor Motor Seizures

Cited by 42 publications

References 12 publications

Prestatus and status dystonicus in children and adolescents

Prestatus and status dystonicus in children and adolescents

Infantile Spasms: Little Seizures, BIG Consequences

Deconstructing tolerance with clobazam

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