Abstracts

Rationale: The prevalence of epilepsy is about 1%, with different literature suggesting 35% of patients have drug resistant epilepsy. The ketogenic diet (KD) is an effective treatment for patients with drug resistant epilepsy. The majority of patients continue to take anti-epileptic medications in combination with their KD. A large percentage of those patients take a benzodiazepine for its high efficacy as an adjunctive therapy in patients with refractory epilepsy. Clonazepam, Clorazepate, and Clobazam are some of the most commonly used adjunctive therapy benzodiazepines. This study is aimed to compare efficacy of treatment using a KD in combination with different benzodiazepine medications. Assessing possible synergy between the KD and those medications.Methods: A prospective study of 73 patients of a total of 186 patients taking a ketogenic diet for drug resistant epilepsy, for both generalized and focal epilepsy, at a level 4 pediatric epilepsy center were studied. Patients' age ranged from birth to 18 years, We looked at the seizure control (more than 50%, less than 50%, or no change from baseline on the ketogenic diet) after the addition of Clonazepam, Clorazepate, or Clobazam in those patients. Assessing the immediate and long term efficacy of the perspective benzodiazepine.Results: Out of the total 73 patients, 42 were identified to have a treatment combination with KD, and a benzodiazepine, with 21 males. 31 were taking Clobazam, 19 taking Clonazepam, and 11 taking Clorazepate. With 19 patients switching from Clonazepam, or Clorarazepate to Clobazam because of lack of efficacy. 16 patients were followed for two years, 14 for one year, 10 for 6 months, and 2 for 3 months after adding the benzodiazepine to the KD. In the first 6 months after initiation, In the Clobazam group, 25 (80%) patients had more than 50% seizure reduction, with 6 becoming seizure free. 3 (10%) patients had less than 50% seizure reduction, and 3 (10%) patients had no seizure reduction. In the Clonazepam group, 7 (36%) patients had more than 50% seizure reduction, 5 (26%) patients had less than 50% seizure reduction, and 4 (21%) patients had no seizure change. In the Clorazepate group, 4 (36%) patients had more than 50% rededication in seizures, 4 (36%) had less than 50% reduction, and 3 (27%) had no seizure change. 2 years follow up, 28 (90%) of patients taking clobazam continued the medicine. 9 (47%) continued clonazepam, and 4 (36%) patients continued ClorazepateConclusions: Benzodiazepines are good adjunctive medications in patients with refractory epilepsy, especially in combination with the ketogenic diet. Among different benzodiazepines, Clobazam had the highest efficacy rates, with the best retention curve. Also was tolerated the most, with less side effects.