Clobazam is a new benzodiazepine recently introduced in Canada on an experimental basis. We report our experience with 27 children (average age 9.1 years) with severe intractable seizure disorders. All had mixed seizures (41% focal plus generalized, 59% mixed generalized) and 93% were mentally retarded. Eighty-five percent had multiple daily seizures and all had been on an average of 6 other anticonvulsants in the past. Forty-one percent of our patients responded to clobazam with a reduction of greater than 75% in seizure frequency and 15% had no further seizures. Tolerance to clobazam which could not be overcome by dose increases developed in 26% of patients. Fortyfour percent of non-responders had exacerbations of their seizures shortly after starting clobazam, however 43% of these patients had reductions in comedications simultaneously. Side effects of clobazam in responders were minimal. We conclude that clobazam shows sufficient promise to warrant further trials in more benign seizure disorders in children.
RESUME: Le clobazam dans le traitement des crises convulsives refractaires chez I'enfant -Un medicament d'appoint precieuxLe clobazam est une nouvelle benzodiazepine qui a ete introduite au Canada recemment sur une base experimentale. Nous rapportons notre experience chex 27 enfants (age moyen 9.1 ans) presentant des crises convulsives refractaires au traitement. Tous avaient des crises mixtes (focales et generalisees chex 41%, mixtes generalisees chez 59%) et 93% souffraient d'un retard mental. Quatre-vingt-cinq pourcent presentaient plusieurs crises par jour et tous avaient recu en moyenne 6 autres anticonvulsivants par le passe. Quarante-et-un pourcent de nos patients ont repondu au clobazam par une reduction de la frequence des crises de plus de 75% et 15% n'ont pas presente d'autre crise. Vingt-six pourcent des patients ont developpe une tolerance au clobazam qui n'a pu etre vaincue par une augmentation de la posologie. Quarante-quatre pourcent des non-repondeurs ont presente une exacerbation des crises peu apres avoir commence a prendre le clobazam. Cependant, la medication associee a ete reduite simultanement chez 43% de ces patients. Les effets secondaires du clobazam ont ete minimes chez les repondeurs. Nous concluons que le clobazam est suffisamment prometteur pour justifier des etudes ulterieures chez les enfants atteints de desordres convulsifs plus benins.
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