CLONAZEPAM IN THE TREATMENT OF EPILEPSY

Sixty epileptic outpatients were treated during 2 weeks‐2 years with clonazepam (Ro 5‐4023) alone, or combined with conventional anticonvulsants in a daily maintenance dosage of usually 3–9 mg (0.5–16). Fifty per cent reduction in the frequency of fits or more was obtained, at least temporarily, in all types of seizures treated. Thirteen (68 per cent) out of 19 patients with pycnoleptic petit mal became free of seizures, and among these 8 patients were treated with clonazepam alone. Two patients (1 of these treated with clonazepam alone) with pycnoleptic petit mal had a reduction in the number of seizures of more than 75 per cent. Four out of 18 patients with psychomotor seizures became free of attacks. In all, 11 patients (61 per cent) had a reduction of more than 50 per cent. The number of patients with other types of seizures is too small to permit an evaluation of the results. In 9 patients the improvement diminished, or disappeared, after 1–12 months' treatment with clonazepam, usually within the first 3 months. Increased grand mal occurred in 4 patients. In 2 of these no relationship to clonazepam treatment was considered, whereas this could not be excluded in the last 2 patients. It is emphasized that in the case of clonazepam discontinuance, the dosage should be gradually decreased in order to avoid convulsions due to withdrawal. Side‐effects were seen in 39 patients, and in 12 of these clonazepam treatment had to be stopped. Various degrees of sedation occurred frequently, whereas psychic disturbances such as agitation and aggressiveness were seen in 3 children and 1 adult. The frequency of side‐effects was significantly lower when the initial dosage was lower than 3 mg clonazepam daily (p < 0.005). No significant difference in regard to frequency of side‐effects could be found between patients treated with clonazepam combined with phenobarbital and primidon, and those patients treated with clonazepam alone or in combination with phenytoin or other drugs.