Abstracts

Rationale: Clobazam was approved in October 2011 for adjunctive treatment of seizures associated with Lennox Gastaut syndrome. In the present study, we evaluated efficacy of clobazam adjunctive treatment in refractory focal epilepsy in adults at a single epilepsy center. Methods: We performed an audit of all patients with refractory focal epilepsy with partial complex or simple motor seizures treated adjunctively with clobazam between 2012-14 at a single epilepsy center. Baseline evaluation included 4 months of seizure diaries. Baseline medications were chosen and dosed according to best clinical judgment of treating physicians. Clobazam was added to current medications; after its initiation background medications were unchanged unless clobazam failed to improve seizures at maximally tolerated dose. Clobazam dosing was titrated up to either seizure freedom or clinical toxicity, with general target dose of 40 mg/day. Seizure diaries were reviewed at regular intervals by epileptologists in face to face interviews. Only patients with clobazam treatment of ≥ 6 months or with clobazam treatment failure before 6 months of treatment were included in the analysis. Seizure frequency per 28 days on was compared between whole clobazam treatment period starting at month 2 with 4 months of baseline. Seizure freedom was defined as 0 seizures for ≥ 6 months. Results: 22 patients were treated with clobazam (9 M, 13 F). Mean age was 41 years, duration of epilepsy 21.6 years, mean number of previous AEDs 7.4 (range 2-15), mean number of concomitant AEDs during clobazam treatment 2.4 (range 1-4), and median pre-treatment seizure frequency 6.8 per 28 days. Average treatment duration was 6.9 months (range 0.5-28). 10/22 (45%) patients stopped clobazam before 6 months, including 8 (36%) because of lack of efficacy and 3 (14%) because of adverse events. Clobazam dose ranged from 10-60 mg/day. Mean monthly seizure frequency decreased by 42.1 % (p=<0.01). 4/22 (18%) patients had sustained 50% seizure frequency reduction, the same number of patients (18%) had 75% and 90% seizure frequency reduction, including 2 patients (9%) who became seizure free. 8 patients (36%) had initial seizure improvement with subsequent return of seizures back to baseline after 1-6 months, including 5 patients with initial >