Efficacy and Tolerability of Adjunctive Clobazam in Older Adults with Drug Resistant Epilepsy
Abstract number :
3.291
Submission category :
7. Anti-seizure Medications / 7C. Cohort Studies
Year :
2021
Submission ID :
1825902
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Marjorie Bunch, MD, FAES - Albany Medical Center; Bridget Frawley - Albany Medical Center; Timothy Lynch - Albany Medical Center; Elanagan Nagarajan - Albany Medical Center
Rationale: Clobazam is a long acting benzodiazepine used to treat epilepsy. Older patients may be more vulnerable to side effects from benzodiazepines. This study was undertaken to evaluate the efficacy and tolerability of clobazam in adult epilepsy patients age 50 years and older.
Methods: This was a single center retrospective chart review of patients 50 years of age or older with drug resistant epilepsy who started clobazam as add-on therapy. Patients who filled at least one prescription for clobazam between 8/1/2015 and 1/31/2020 were identified through the NY State Prescription Monitoring Program Registry. Seizure frequency and side effects were recorded at 6 and 12 months after initial clobazam prescription and at last follow up. Reasons for drug discontinuation were recorded and results summarized.
Results: 26 patients were identified. Mean age at clobazam initiation was 62 +/- 7.1 years, and 18 (69.2%) patients identified as female. The mean baseline seizure frequency before initiation of clobazam was 2 (range 1-30) seizures per month, excluding two patients who had innumerable seizures for whom baseline count was unable to be estimated. The average number of prior seizure medications was 4.2 (range 2 – 9).
12 months after clobazam initiation 6 patients (23%) discontinued use and all within one month of initiation, 8 (31%) patients were seizure-free and an additional 9 (35%) had a greater than 50% reduction in seizure frequency. The mean seizure frequency at 12-month follow up was 1.5 (range 0-24) seizures per month with mean total daily dose of clobazam 14.25 (range 5 to 25) mg. The mean duration of clobazam use at last follow up was 55.2 +/- 27.02 (mean +/- SD months) and 18 (69.2%) patients remained on clobazam. 20 out of the 26 (76.9%) patients reported at least one side effect. Most common side effects were sedation and unsteady gait. At last follow up, 23% remained seizure free on stable dosing.
Conclusions: Clobazam is an effective add on treatment in older adults with drug-resistant epilepsy. Clobazam was well tolerated in those who responded to the medication although frequent side effects were reported. Seizure freedom was noted at submaximal doses and did not require dose augmentation over time.
Funding: Please list any funding that was received in support of this abstract.: None.
Anti-seizure Medications