Adjuvant clobazam

[lymphocyte]

Dear colleagues, I am not a neurologist but I just wanted to learn something.

I was doing a locum shift at a small rural hospital when somebody presented with a first episode self-limiting focal aware seizure after GBM resection + chemoradiotherapy several months ago. CTB showed stable findings c/f one a month ago. I loaded with Keppra 1.5g PO.

I was going to send them home on Keppra 750mg BD with outpatient follow-up. Neurologist was happy but also wanted a few days of 10mg BD clobazam too. Didn't explain his rationale. I admit I'm a little puzzled. Is this a common regimen?

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[Telamir]

Not really, but not unreasonable.

For known epileptics (and pretty common in kids) if they're going through something like a cold it's not unreasonable to give them a low dose of clonazepam for a few days, say 0.5-1mg TID. I've done this for the cerebral palsy/epilepsy patients that make it to me in adulthood and it works relatively well. The rationale with clonazepam and I assume the same with Clobazam is that they are relatively long lasting benzos, and you'd keep a "steady state" of benzos for a few days the idea being to increase the seizure threshold. The thought being that the brain is more "irritable" over the coming days, I suppose.

I personally reach for clonazepam over clobazam for this indication since it's much cheaper; however clobazam is a good adjuvant for focal seizures regardless.

I probably wouldn't have done it in this situation but like I said, it's not unreasonable.

 

[lymphocyte]

Not really, but not unreasonable.

For known epileptics (and pretty common in kids) if they're going through something like a cold it's not unreasonable to give them a low dose of clonazepam for a few days, say 0.5-1mg TID. I've done this for the cerebral palsy/epilepsy patients that make it to me in adulthood and it works relatively well. The rationale with clonazepam and I assume the same with Clobazam is that they are relatively long lasting benzos, and you'd keep a "steady state" of benzos for a few days the idea being to increase the seizure threshold. The thought being that the brain is more "irritable" over the coming days, I suppose.

I personally reach for clonazepam over clobazam for this indication since it's much cheaper; however clobazam is a good adjuvant for focal seizures regardless.

I probably wouldn't have done it in this situation but like I said, it's not unreasonable.

Yes, this makes sense. I just hadn't encouraged this kind of strategy right off the bat before and was worried I missed something new in the literature. Thanks for that.