Abstracts

Rationale: Clobazam is FDA approved for Lennox-Gastaut syndrome, but is becoming more commonly used for patients with other types of intractable epilepsy.  It is considered FDA pregnancy category C, “risk not ruled out” and crosses the placenta, but there is little data on fetal malformations, neonatal withdrawal problems, or cognitive outcomes.  Data for other benzodiazepines suggests there may be risk for neonatal dependence and withdrawal.  Clobazam is reported to be excreted into breastmilk in low levels, but there is limited data on its use during breastfeeding.   Methods: Chart review of a patient who became pregnant while taking clobazam. Results: A 20-year-old woman with intractable juvenile myoclonic epilepsy since childhood with generalized tonic clonic (GTC), absence, and myoclonic seizures became pregnant while taking lamotrigine and clobazam.  She previously tried and failed valproic acid, levetiracetam, topiramate, gabapentin, and ethosuximide.  Prior to pregnancy, she was having a GTC seizure approximately every other month, but this increased to one per month during pregnancy.  During the first and second trimesters, clobazam and lamotrigine were both increased, but she continued to have monthly seizures.  At 22 weeks gestation, zonisamide was added to clobazam and lamotrigine in an effort to reduce seizure burden.  At 32 weeks gestation, after being seizure free for 10 weeks on the three medications, the option of very slowly reducing the clobazam dose was offered to the patient.  This was done in an effort to reduce the potential risk of neonatal withdrawal, particularly because she was not planning to breastfeed.  At 33 and 36 weeks gestation she had short admissions for preterm labor and was discharged home both times.  During the second admission she had two seizures after being up all night and receiving promethazine and morphine.  No further clobazam reduction occurred after that point.  At 38 weeks, 3 days gestation she had a seizure at home, so was admitted for induction.  At 38 weeks, 4 days she delivered a healthy baby boy weighing 7 pounds, 2.6 ounces and with Apgar scores of 9/9.  She maintained her decision not to breastfeed and the baby showed no signs of neonatal benzodiazepine withdrawal.  Conclusions: A case of a young woman who became pregnant while taking clobazam who had a healthy baby boy with no signs of neonatal benzodiazepine withdrawal was presented.  At present, there are no guidelines for monitoring or counseling women who become pregnant while taking clobazam.  There also are no guidelines for monitoring the neonate after delivery, although there are cautions about the possibility of neonatal withdrawal based on experience with other benzodiazepines.  More data is needed about the use of clobazam during pregnancy, both in mono- and polytherapy, as it is being prescribed to increasing numbers of reproductive age women. Funding: N/A