Adjunctive Therapy in Resistant Epilepsy

Abstract

It is now established that the overall prognosis for epilepsy is good and that remission will occur in at least 75% of patients following adequate treatment with monotherapy. Patients who fail to respond to monotherapy, who are not suitable for surgery, and who continue to have frequent seizures may have to be considered for an alternative drug regimen. A review of the literature indicates that complete seizure control with adjunctive treatment is rare, but improved seizure control can be obtained in up to 40% of patients. In a study of clobazam as adjunctive treatment, 60% (N = 20) of our patients responded to treatment initially and 33% maintained an improvement over an 18-month period. In 31 patients who failed to respond to carbamazepine as monotherapy, primidone (N = 16) or valproate (N = 15) were prescribed as adjunctive treatment. One patient obtained complete freedom from seizures and 14 (45%) had a greater than 50% reduction in seizure frequency. Suggested indications for the use of additive treatment in epilepsy are discussed.

Pharmacokinetics of N‐desmethylclobazam in healthy volunteers and patients with epilepsy.

“…The steady-state concentrations achieved in patients in this study are of the same order as those found in epileptic patients receiving therapeutic doses of clobazam (Callaghan & Goggin, 1984). In our patients receiving chronic dosing, steady-state concentrations were much higher in males than in females.…”

Anti-epilepsy Effect of Methanol Extract of Morinda officinalis Augments Pentylenetetrazol-Induced Convulsion Behaviors

“…하는 효소이다 (Dulac and Arthuis, 1984;Elwes et al, 1984;Callaghan and Goggin, 1988 (Stohs, 1995;Douglas, 1998 (Cohen and Doherty, 1987;Behl et al, 1994;Bejma and Ji, 1999). …”

The effect of clobazam on steady state plasma concentrations of carbamazepine and its metabolites.

“…Clobazam (CLB) is a 1,5-benzodiazepine commonly used as adjunct therapy in the treatment of resistant epilepsy (Callaghan & Goggin, 1988;Robertson, 1986). It is metabolized to Ndesmethylclobazam, which has also been successfully used in the treatment of refractory epilepsy .…”