Clinical considerations in transitioning patients with epilepsy from clonazepam to clobazam

A case series

Raman Sankar, Steve Chung, Michael Scott Perry, Ruben Kuzniecky, Saurabh Sinha

Research output: Contribution to journalArticle

Abstract

Introduction: 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. Case presentations: 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.

Original languageEnglish (US)
Article number429
JournalJournal of Medical Case Reports
Volume8
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Clonazepam
Epilepsy
Seizures
etiracetam
Stroke
Absence Epilepsy
Patient Transfer
Tuberous Sclerosis
Valproic Acid
Paresis
Hispanic Americans
Intellectual Disability
Pharmacokinetics
Quality of Life
clobazam
Guidelines
Drug Therapy

Keywords

  • Clobazam
  • Clonazepam
  • Switching
  • Transition

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Clinical considerations in transitioning patients with epilepsy from clonazepam to clobazam : A case series. / Sankar, Raman; Chung, Steve; Perry, Michael Scott; Kuzniecky, Ruben; Sinha, Saurabh.

In: Journal of Medical Case Reports, Vol. 8, No. 1, 429, 2014.

Research output: Contribution to journalArticle

Sankar, Raman ; Chung, Steve ; Perry, Michael Scott ; Kuzniecky, Ruben ; Sinha, Saurabh. / Clinical considerations in transitioning patients with epilepsy from clonazepam to clobazam : A case series. In: Journal of Medical Case Reports. 2014 ; Vol. 8, No. 1.
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