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Response to clobazam in continuous spike‐wave during sleep
Author(s) -
Vega Clemente,
Sánchez Fernández Ivan,
Peters Jurriaan,
ThomeSouza Maria S,
Jackson Michele,
Takeoka Masanori,
Wilkening Greta N,
Pearl Phillip L,
Chapman Kevin,
Loddenkemper Tobias
Publication year - 2018
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.13607
Subject(s) - clobazam , neuropsychology , anesthesia , spike and wave , psychology , medicine , electroencephalography , cognition , audiology , pediatrics , epilepsy , psychiatry
Aim To evaluate the efficacy of clobazam treatment in reducing epileptiform discharges and modifying neuropsychological function in continuous spike‐wave during slow wave sleep. Method We performed a prospective clinical trial in patients with continuous spike‐wave during sleep aged 4 to 10 years. Patients underwent neuropsychological assessment and overnight electroencephalographic monitoring before treatment, and subsequent repeat assessment and overnight electroencephalographic monitoring 3 months after treatment. Treatment consisted of 1mg/kg clobazam up to a maximum dose of 30mg during the first night, followed by 0.5mg/kg nightly for 3 months. Results Nine patients completed the study and had pre‐ and post‐neuropsychological evaluation. There was a qualitative reduction in median (p 25 –p 75 ) spike percentage after 3 months (72.2 [68.0–75.8] vs 32.7 [4.7–81.7]). There were no marked changes in median (p 25 –p 75 ) IQ comparing pre‐ and post‐clobazam treatment (80.0 [74.0–88.0] vs 80.0 [67.0–89.0]). There was a qualitative increase in Verbal IQ (83.0 [69.0–92.0] vs 95.0 [83.0–99.0]) and a qualitative decrease in Non‐verbal IQ (84.0 [74.0–87.0] vs 71.0 [60.0–84.0]). Interpretation Qualitative improvements in epileptiform activity and cognition occurred in patients treated with clobazam for 3 months and the relationship between epileptiform activity and cognitive outcome should be studied in larger studies. What this paper adds Verbal IQ in patients with continuous spike‐wave during sleep improved following short‐term treatment with clobazam. Other neuropsychological improvements were observed, but varied by patient. Cognitive improvement was observed despite some worsening of epileptiform discharges.