title: Clobazam: An effective add-on therapy in refractory status epilepticus.
abstract: Refractory status epilepticus (RSE) is a medical emergency, with significant morbidity and mortality. The use and effectiveness of clobazam, a unique 1,5-benzodiazepine, in the management of RSE has not been reported before. Over the last 24 months, we identified 17 patients with RSE who were treated with clobazam in our hospital. Eleven of the 17 patients had prior epilepsy. Fifteen patients had focal status epilepticus. Use of clobazam was prompted by a favorable pharmacokinetic profile devoid of drug interactions. Clobazam was introduced after a median duration of 4 days and after a median of three failed antiepileptic drugs. A successful response, defined as termination of RSE within 24 h of administration, without addition or modification of concurrent AED and with successful wean of anesthetic infusions, was seen in 13 patients. Indeterminate response was seen in three patients, whereas clobazam was unsuccessful in one patient. Clobazam averted the need for anesthetic infusions in five patients. Clobazam was well tolerated, and appears to be an effective and promising option as add-on therapy in RSE. Its efficacy, particularly early in the course of SE, should be further investigated in prospective, randomized trials.
authors.affiliation: Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sivakumar
authors.affiliation: Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ibrahim
authors.affiliation: Eugene Applebaum College of Pharmacy and Health Sciences/Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Dennis
authors.initials: D
authors.lastname: Parker
authors.affiliation: Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Gregory
authors.initials: G
authors.lastname: Norris
authors.affiliation: Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Aashit
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Wazim
authors.initials: W
authors.lastname: Mohamed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects / Q000473:pathology; D000078306:Clobazam; D004569:Electroencephalography; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy* / Q000473:pathology; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D001569:Benzodiazepines; D000078306:Clobazam
keywords: Benzodiazepine; Clobazam; Electroencephalography; Oral antiepileptic; Status epilepticus