Benzodiazepines for epilepsy
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Clonazepam is the most commonly used benzodiazepine for long-term treatment of epilepsy. It is available in tablet form.
Diazepam and lorazepam are given in a vein (intravenous, or IV) for the treatment of prolonged seizures or status epilepticus. Diazepam is also available in a gel form that can be injected into the rectum by a caregiver during clusters of seizures (acute repetitive seizures).
These medicines are used in infants and children but with careful dosage adjustments based on weight and age.
How It Works
Benzodiazepines are minor tranquilizers (sedatives) that prevent or stop seizures by slowing down the central nervous system. This makes abnormal electrical activity less likely.
Why It Is Used
Clonazepam may be used to treat:
- Myoclonic seizures.
- Absence seizures , especially when valproate or ethosuximide have failed to control the seizures.
- Infantile spasms (not common).
- Lennox-Gastaut syndrome (not common).
IV diazepam and lorazepam are often used to treat prolonged seizures or status epilepticus. Diazepam may be used during short periods of increased, repeated, or prolonged seizures (acute repetitive seizures) in people who are taking other antiseizure drugs for long-term treatment.
How Well It Works
In general, benzodiazepines are not usually the first choice for long-term treatment of epilepsy. Although clonazepam or clorazepate may be quite helpful for a few people, most people do not respond very well to them over the long term.
But occasional use of diazepam to treat seizures can be very effective. Treatment with rectal diazepam within 15 minutes of the beginning of a prolonged seizure or a series of seizures usually ends the seizure activity.
The most common side effects of benzodiazepines include:
- Drowsiness or sedation.
- Loss of muscle coordination.
- Behavior changes (nervousness, confusion, aggression).
- Loss of appetite.
The U.S. Food and Drug Administration (FDA) has issued a warning on clonazepam (Klonopin) and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using this medicine. Instead, people who take clonazepam should be watched closely for warning signs of suicide. People who take clonazepam and who are worried about this side effect should talk to a doctor.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
It may take time and careful, controlled adjustments by you and your doctor to find the combination, schedule, and dosing of medicine to best manage your epilepsy. The goal is to prevent seizures while causing as few side effects as possible. After you and your doctor figure out the medicine program that works best for you, make sure to follow your program exactly as prescribed.
- Adverse effects. Benzodiazepines are central nervous system depressants, which means that they can slow down your thinking, judgment, and motor skills. These effects are usually not severe, but they are a major drawback for some people.
- Drug interactions. Many medicines for epilepsy can interact with other medicines you may be taking. This means that your epilepsy medicine may not work as well or it may affect the way another medicine you are taking works. Some of these interactions can be dangerous. It is important to tell your doctor about all the medicines, herbal pills, and dietary supplements you are taking.
- Risks associated with long-term use. Long-term use of benzodiazepines can sometimes lead to physical and psychological dependence on the drug (addiction). Use of benzodiazepines may decrease seizures at first. But some people begin to have seizures again after using the drug for weeks or months (tolerance). To control their seizures, they have to increase the dose, which tends to increase side effects. Sudden withdrawal of the drug can cause you to go into status epilepticus or may make your epilepsy worse.
- Risk of birth defects. All medicines for epilepsy have some risk of birth defects. But the risk of birth defects needs to be carefully compared to other risks to the baby if the mother stops taking her epilepsy medicine. If you are thinking about becoming pregnant, be sure to plan ahead and talk with your doctor about the benefits and risks of taking epilepsy medicine during your pregnancy. It you are already pregnant, it is not too late. The best thing to do is talk to your doctor about your pregnancy before you make any changes to the medicines you are taking.
- Ease of use. For children or adults who have occasional clusters of seizures (acute repetitive seizures) despite long-term drug therapy, rectal diazepam may be a good choice for treating them at home. It usually stops the series of seizures quickly, and family members can treat the person at home safely and easily. Ending these types of repetitive seizures can prevent status epilepticus and other problems associated with prolonged seizures and can help families avoid emergency room visits when a family member has a long history of acute repetitive seizures.
- Other concerns. While taking benzodiazepines, avoid alcohol or any other drugs that are central nervous system depressants.