Benzodiazepines for epilepsy

Examples

Generic Name	Brand Name
clonazepam	Klonopin
clorazepate	Tranxene
diazepam	Valium, Diastat
lorazepam	Ativan
midazolam	Versed

Clonazepam is the most commonly used benzodiazepine for long-term treatment of epilepsy. It requires several doses each day and is available in tablet form.

Diazepam and lorazepam are available in an intravenous (IV) form for the treatment of prolonged seizures or status epilepticus. Diazepam is also available in a gel form (Diastat) that can be injected into the rectum by a caregiver during clusters of seizures (acute repetitive seizures).

These medications 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. Diastat (the rectal gel form of 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 run.

Occasional use of diazepam to treat seizures, however, can be very effective. Treatment with rectal diazepam (such as Diastat) within 15 minutes of the beginning of a prolonged seizure or a series of seizures frequently ends the seizure activity.

Side Effects

The most common side effects of benzodiazepines include:

• Drowsiness or sedation.
• Loss of muscle coordination.
• Behavior changes (nervousness, confusion, aggression).
• Loss of appetite.

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 medication to best manage your epilepsy. The goal is to prevent seizures while causing as few unwanted side effects as possible. Once the most effective medication program is determined, it is important that you follow it 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.
• 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. More than occasional use of benzodiazepines is generally not recommended for pregnant women. Benzodiazepines increase the risk of birth defects and may also lead to other problems in the baby.
• Ease of use. For children or adults who have occasional clusters of seizures (acute repetitive seizures) despite long-term drug therapy, rectal diazepam (Diastat) 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. Avoid alcohol or any other drugs that are central nervous system depressants while taking benzodiazepines.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Author:	Monica Rhodes	Last Updated November 11, 2005
Medical Review:	Michael J. Sexton, MD - Pediatrics Steven C. Schachter, MD - Neurology
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