Abstracts

Rationale: Klonopin® wafers (clonazepam orally disintegrating tablets) are a benzodiazepine with anticonvulsive and anxiolytic effects. Its precise mechanism is unknown although it is believed to enhance the activity of gamma aminobutyric acid (GABA). Our institution has been prescribing clonazepam wafers for the acute treatment of prolonged (more than 5 minutes) seizures for several years. Depending on the size of the patient, they were prescribed: 0.25 mg, 0.5 mg, 1.0 mg or 2.0 mg wafers. We proceeded to obtain evidence for the efficacy of this practice. Methods: Hospital Institutional Review Board (IRB) approval was obtained for an anonymous patient survey. All children (less than 21 years of age) who had been prescribed clonazepam wafers over a six year period at our institution were mailed a detailed questionnaire (in English and Spanish). After five weeks, data from the returned questionnaires was collected and analyzed. Results: Three hundred and eighty-one questionnaires were mailed. There were 79 replies. Thirty-one were excluded as the surveys reported the patient had never been prescribed clonazepam, were prescribed clonazepam for reason other than seizure, had yet to use it for prolonged seizures or their answers were ambiguous. Data was collected from the remaining 48 patients. Their average age was 9.5 (range = 2-23) years. There were 26 males. Only four patients did not have a history of developmental impairment and/or cerebral palsy. Efficacy was defined as clonazepam stopping the seizures within 10 minutes, >50% of the time. Thirty-six of the 48 (75%) patients met this criterion. From these 36 patients, 16 (44%) had their seizures stopped within one minute, 12 (33%) between 1-5 minutes and eight (22%) between 1-10 minutes. Overall the results were comparable to Diastat® (rectal diazepam) amongst the patients who had been treated with both. Conclusions: Clonazepam wafers are an effective acute therapy for prolonged seizures. We believe that in cases of inefficacy, many of these patients were probably prescribed an insufficient dose. The relative ease of administration of this treatment may make it a viable, less expensive option than Diastat®. Further, prospective, randomized studies are planned.