Abstracts

Benzodiazepines are rarely used as long term therapy for patients with epilepsy. However, once traditional antiepileptic drugs have failed an adjunct trial may be justified to help reduce seizure frequency. We performed a retrospective chart review of patients from the Baylor Comprehensive Epilepsy Program Outpatient Clinic. Patients who had been started on Tranxene SD (a sustained release preparation of Clorazepate) were enrolled into the study. Five patients with refractory epilepsy, met criteria for enrollment. Of these patients, two patients had a diagnosis of primary generalized epilepsy, and three had a diagnosis of localization related epilepsy. Seizure frequencies were recorded prior to and after the initiation of Tranxene SD. Baseline seizure frequencies ranged from daily seizures to two seizures a week. Duration of follow-up ranged from 20 days to seven months. The total daily dose ranged from 5.625 mg up to 33.75 mg (either in once or twice a day dosing). Tranxene SD was effective in 100 % of patients, with 3 of 5 patients becoming seizure free. Please see table for detailed results in each patient. Irritability and increased daytime sleepiness were the most common side effects to Clorazepate. These side effects were tolerated well by the patients. Subjective sleepiness was initially reported by patients, which then returned to baseline. In our small series of patients with refractory generalized and localization related epilepsy, a significant reduction in seizure frequency was seen in all patients started on Tranxene SD. The small sample size may be resonsible for the realtively dramatic results seen in our patients. Adverse reactions including increased sleepiness were manageable. The duration of follow-up was relatively short to assess whether tachyphylaxis is a problem with continued treatment. It is possible that treatment with Tranxene SD (or other benzodiazepines) may be useful in short term durations to help decrease seizure frequencies.[table1] (Supported by Peter Kellaway Foundation for Research.)