Systematic review of clobazam use in patients with status epilepticus

Abstract

SummaryClobazam (CLB) is a commonly used oral antiepileptic drug (AED) that has been shown to be effective in various forms of epilepsy. Given its distinct 1,5‐benzodiazepine structure, rapid absorption, minimal drug interactions, and favorable safety profile, CLB displays unique properties when compared to other commonly used benzodiazepines. Recent evidence has shown that CLB may demonstrate therapeutic efficacy in status epilepticus (SE). The objective of this systematic review was to summarize the available evidence pertaining to the efficacy of CLB use in SE. An electronic literature search of Medline (1946 to November 6, 2017), Embase (1974 to November 6, 2017), and the Cochrane Library (1999 to November 6, 2017) databases was performed to identify reports of CLB use in SE. After screening and full text review, a total of 15 articles were included: 8 retrospective studies, 2 case series, and 5 case reports. Efficacy rates for CLB have varied among reports. Overall, based on the retrospective studies, a total of 76 patients with SE have been reported. CLB was introduced within 2–4 days from SE onset and has been reported to contribute to remission in 36 patients (47%). CLB maintenance dose ranged from 10 to 60 mg/day. However, the results need to be interpreted carefully because SE patients are a heterogeneous group with different etiologies and disease severities, and the response to CLB might vary in different patient population or seizure types. In conclusion, there is not sufficient evidence to determine the safety and efficacy of clobazam in the setting of SE. However, the current limited evidence combined with the unique characteristics of CLB suggest that the drug might be considered as an add‐on option in SE patients, with a suggested dosage range of 10–60 mg/day. Prospective studies are needed to fully establish the role of CLB in the management of SE.

Diagnosis and Management of Status Epilepticus

“…The evidence is based on small retrospective studies and case series only. ASMs that are used as add-on therapy include clobazam, 38 topiramate, 39 and perampanel, 40 and recently brivaracetam. 41 There are several nonpharmacological emerging therapies for the treatment of RSE such as neuromodulation (e.g., vagus nerve stimulator [VNS]), ketogenic diet, and hypothermia.…”

Principles of Pharmacotherapy of Seizures and Status Epilepticus

“…Retrospective evaluations reporting its use at a median dose of 20 mg per day as an add-on for RSE have shown variable efficacy (25-76%). 47 Perampanel is unique in that it is a selective noncompetitive AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid) antagonist, so it represents a novel approach to the management of RSE. A recent retrospective analysis of 22 patients with RSE who received perampanel showed a response of 36.4% within 4 days of initiation, which was higher than previous analyses that showed a positive response of 17%.…”

NiFe2O4@SiO2@PrNH2–DPA–CeCl3: a cerium-based magnetic nano dual-acid catalyst with high efficacy and recyclability for domino sequential synthesis of lactam ring-fused 1,5-benzodiazepines

“…[9][10][11][12] The lactam ring also occupies an essential position in heterocyclic species, maintaining the antibacterial activity of certain compounds. [13][14][15][16][17] There are diverse 1,5-benzodiazepines with a lactam structure that exhibit superior clinical pharmacodynamic effects, such as clobazam, 18,19 C1414S, 20,21 nevirapine [22][23][24] and arfendazam, 25,26 which proves that the fusion of a lactam structure is worthy of attempting during the synthesis of 1,5-benzodiazepines to enhance pharmacological activity.…”