Status epilepticus clonazepam

Given intravenously, both diazepam and midazolam are effective first-line treatments for status epilepticus. It is essential to be aware that the large doses that may be necessary to control convulsions are likely to cause respiratory depression and obtund protective reflexes. Oxygen and equipment suitable for its administration should be available. For intractable status epilepticus, clonazepam is a longer-acting alternative which can also be given by intravenous infusion. Overdosage... 

Benzodiazepines Diazepam and lorazepam are preferred drugs for status epilepticus. Clonazepam is used for absence seizures. Described in tables 3.8A and 3.8C. 

Clonazepam, a typical 1 4 benzodiazepine, is effective in absence seizures, myoclonic jerks and tonic-clonic seizures and given intravenously it attenuates status epilepticus. It is less sedative than phenobarbitone but tolerance develops and its withdrawal, as... 

Benzodiazepines are the drugs of choice for status epilepticus (see above) however, development of tolerance renders them less suitable for long-term therapy. Clonazepam is used for myoclonic and atonic seizures. Clobazam, a 1,5-benzodiazepine exhibiting an increased anticonvulsant/seda-tive activity ratio, has a similar range of clinical uses. Personality changes and paradoxical excitement are potential side effects. 

Several members of the benzodiazepine group are effective in treating epilepsy, but most are limited because of problems with sedation and tolerance. Some agents such as diazepam (Valium) and lorazepam (Ativan) are used in the acute treatment of status epilepti-cus (see Treatment of Status Epilepticus ), but only a few are used in the long-term treatment of epilepsy. Clonazepam (Klonopin) is recommended in specific forms of absence seizures (e.g., the Lennox-Gastaut variant) and may also be useful in minor generalized seizures such as akinetic spells and myoclonic jerks. Clorazepate (Tranxene) is another benzodiazepine that is occasionally used as an adjunct in certain partial seizures. 

Benzodiazepines used to treat epilepsy include diazepam, clonazepam, clobazam and lorazepam. Of these, diazepam and lorazepam have been most widely used to control status epilepticus, while use of clonazepam is usually restricted to the chronic treatment of severe mixed types of seizures (e.g. Lennox-Gastaut syndrome and infantile spasm). The major problem with most of the benzodiazepines, with the possible exception of clobazam, is sedation. 

Seizures Clonazepam [kloe NA ze pam] is useful in the chronic treatment of epilepsy, whereas diazepam is the drug of choice in terminating grand mal epileptic seizures and status epilepticus (see p. 149). Chlordiazepoxide [klor di az e POX ide], clorazepate [klor AZ e pate], diazepam, and oxazepam [ox A ze pam] are useful in the acute treatment of alcohol withdrawal. 

A 41-year-old woman developed seizures that progressed to status epilepticus, and died from secondary rhabdomyolysis and disseminated intravascular coagulation (128). She had been taking olanzapine 10 mg/ day for 5 months. No other toxic, metabolic, or anatomical abnormalities were identified pre- or postmortem to explain the seizures. However, her medications also included levothyroxine 0.15 mg/day, clonazepam 1.0 mg qds, and propranolol 20 mg tds. 

Clonazepam (Rivotiil) (tV 25 h) is a benzodiazepine used as a second line drug for treatment of primary generalised epilepsy and for status epilepticus (see Table 20.1). 

Anticonvulsant Agents — Clonazepam (2f) was clinically useful in the treatment of akinetic and myoclonic seizures,22 intention myoclonus,23 tic douloureux24 and has been recorded as the drug of choice for status epilepticus.25... 

Phenobarbital has selective antiseizure activity at low doses and has a long half-life suitable for maintenance treatment in seizure disorders (for characteristics of barbiturates, see sedative-hypnotics). Clonazepam is usually a backup drug in absence and myoclonic seizures it causes marked sedation at anticonvulsant doses. IV lorazepam and diazepam are both used in status epilepticus. 

A large number of benzodiazepines have broad antiseizure properties, but only clonazepam (Klonopin) and clorazepate (Tranxene-SD, others) have been approved in the United States for the long-term treatment of certain types of seizures. Diazepam (Valium, Diastat, others) and lorazepam (Ativan) have well-defined roles in the management of status epilepticus. 

The concurrent administration of valproate and clonazepam rarely has been associated with the development of absence status epilepticus. 

A) Alprazolam is effective in the management of obsessive-compulsive disorders Clonazepam has effectiveness in patients who suffer from phobic anxiety states Diazepam is used for chronic management of bipolar affective disorder in patients who are unable to tolerate lithium Intravenous buspirone is usefiil in status epilepticus... 

Clonazepam a benzodiazepine is effective in all types of epilepsy viz., grand mal, psychomotor, petit mal, myoclonic and status epilepticus. However, diazepam another benzodiazepine is preferred in status epilepticus. It possesses minor side effects. 

A 76-year-old woman with seizures secondary to ischemic stroke developed status epilepticus despite treatment with clonazepam. She was given intravenous levetiracetam 1000 mg/day and 2 days later developed pancytopenia, with a hemoglobin concentration of 9.8 g/dl, a platelet count of 83 x 10 A, and a white blood cell count of 5.7 x 10 /1. These changes worsened during the next 4 days and she required blood transfusion. Levetiracetam was withdrawn and 2 days later the blood cell count improved. When rechallenge with oral levetiracetam 0.5 g/day 1 year later pancytopenia rapidly recurred. 

In 12 adults with status epilepticus, intravenous levetiracetam 2500 mg was added as soon as possible to a standardized regimen of intravenous clonazepam and/or rectal diazepam as needed followed by phenytoin or valproic acid no serious adverse effects could be related directly to the administration of levetiracetam [208 ]. 

Clonazepam may aggravate grand mal seizures in some patients, and status epilepticus has been induced by i.v. injection of clonazepam in patients with tonic seizures and slow spike and wave changes on the EEC. Abrupt discontinuation of the drug can also precipitate status epilepticus (9 ). Throm-... 

Status epilepticus is traditionally defined as a situation where there is continuous seizure activity for a period of 30 minutes or where there are a continuous series of seizures during which the sufferer does not regain consciousness. More recently, it has been suggested that any continuous seizure period of longer than 5 minutes should be classified as status epilepticus. In these situations the treatment employed may well consist of one of the previously indicated antiepileptic dmgs such as clonazepam (Fig. 13.15), phenobarbital and phenytoin (Fig. 13.15) or alternatively diazepam, fosphenytoin (a prodrug of phenytoin), loraze-pam, midazolam and paraldehyde (Fig. 13.16) may be employed. For the drugs used in the treatment of status epilepticus, the formulation and dose differ from conventional doses due to the situation and thus many of these will be administered by intravenous injection, intravenous infusion, buccal or rectal administration. 

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