title: Clinical considerations in transitioning patients with epilepsy from clonazepam to clobazam: a case series.
abstract: BACKGROUND
  In treating refractory epilepsy, many clinicians are interested in methods used to transition patients receiving clonazepam to clobazam to maintain or increase seizure control, improve tolerability of patients' overall drug therapy regimens, and to enhance quality of life for patients and their families. However, no published guidelines assist clinicians in successfully accomplishing this change safely.
  
  
  METHODS
  The following three case reports provide insight into the transition from clonazepam to clobazam. First, an 8-year-old Caucasian boy with cryptogenic Lennox-Gastaut syndrome beginning at 3.5 years of age, who was experiencing multiple daily generalized tonic-clonic, absence, myoclonic, and tonic seizures at presentation. Second, a 25-year-old, left-handed, White Hispanic man with moderate mental retardation and medically refractory seizures that he began experiencing at 1 year of age, secondary to tuberous sclerosis. When first presented to an epilepsy center, he had been receiving levetiracetam, valproate, and clonazepam, but reported having ongoing and frequent seizures. Third, a 69-year-old Korean woman who had been healthy until she had a stroke in 2009 with subsequent right hemiparesis; as a result, she became less physically and socially active, and had her first convulsive seizure approximately 4 months after the stroke.
  
  
  CONCLUSIONS
  From these cases, we observe that a rough estimate of final clobazam dosage for each mg of clonazepam under substitution is likely to be at least 10-fold, probably closer to 15-fold for many patients, and as high as 20-fold for a few. Consideration and discussion of the pharmacokinetic, pharmacologic, and clinical properties of 1,4- and 1,5-benzodiazepine action provide a rationale on why and how these transitions were successful.
authors.affiliation: Division of Pediatric Neurology, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Room 22-474 MDCC, Los Angeles, CA 90095-1752, USA. RSankar@ucla.edu.
authors.forename: Raman
authors.initials: R
authors.lastname: Sankar
authors.forename: Steve
authors.initials: S
authors.lastname: Chung
authors.forename: Michael Scott
authors.initials: MS
authors.lastname: Perry
authors.forename: Ruben
authors.initials: R
authors.lastname: Kuzniecky
authors.forename: Saurabh
authors.initials: S
authors.lastname: Sinha
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D002648:Child; D000078306:Clobazam; D002998:Clonazepam / Q000627:therapeutic use*; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D000927:Anticonvulsants; D001569:Benzodiazepines; D000078306:Clobazam; D002998:Clonazepam