CLB add-on treatment in patients with epileptic encephalopathy: a single center experience with long-term follow-up

Abstract

Clobazam (CLB) is an effective anticonvulsant used as an adjunctive treatment for several seizures and epilepsy syndromes. Data are limited on efficacy and safety of CLB as add-on therapy for epileptic encephalopaties (EEs) other than Lennox-Gastaut syndrome (LGS). This retrospective study aimed to assess efficacy and safety of long-term CLB add-on therapy for various EE syndromes. Data on CLB add-on therapy were assessed in 74 children (60.8% male) after 3 months (early) and 12 months (late) follow-up as well as in 57 (77%) patients who had been on CLB therapy longer than 12 months (mean:39.11 +/- 30.29; range:12-129 months) (very late) were reported. Data on CLB add-on therapy were assessed in 74 children (60.8% male) after 3 months (early) and 12 months (late) follow-up as well as in 57 (77%) patients who had been on CLB therapy longer than 12 months (mean:39.11 +/- 30.29; range:12-129 months) (very late) were reported. Good response rate (> 50%) for seizures was achieved in 24% at early follow-up, 30% at late follow-up, and 35% during very late follow-up. Complete seizure remission was achieved for 15% seizures; 72.7% occurred at very late follow-up. Myoclonic seizures were the most responsive (35%); this response increased during late follow-up (46%), whereas 27.3% of myoclonic-atonic/atonic seizures had good response at early and very late follow-up. At late follow-up, comparison of mean effective doses of CLB did not show significant difference among types of seizures with good response. Adverse effects reported in 15% of patients did not require stopping CLB therapy. Generalized epileptogenic potentials significantly decreased while focal epileptogenic potentials significantly increased at first year of treatment in comparison to basal EEG findings (p < 0.001). CLB should be considered as an optional antiepileptic that is well tolerated, particularly in EEs with myoclonic and myoclonic-atonic/atonic seizures.