Such benzodiazepines as chlorazepate, clobazam, clonazepam, diazepam, lorazepam, and nitrazepam may be used in patients with epilepsy and developmental disabilities (DDs) as antiepileptic, anxiolytic, or sedative hypnotic drugs.17 Benzodiazepines also appear to have limited antidepressant18 and antimanic19 properties. Their tendency to cause sedation, cognitive impairment, tolerance, and addiction limit their utility as chronic antiepileptic therapy.21

Because of their broad-spectrum antiepileptic properties, they have been used to treat Lennox-Gastaut syndrome, an epileptic syndrome characterized by generalized seizures (typically tonic, atonic, myoclonic, and atypical absence), characteristic spike and wave complexes and, usually, cognitive dysfunction.20 When intravenous benzodiazepines are administered to patients with the Lennox-Gastaut syndrome, however, they rarely may induce generalized status epilepticus22 or convert absence status to generalized tonic status epilepticus.23

Adverse psychotropic effects among DD patients include behavioral abnormalities such as:4,17

  • hyperactivity
  • restlessness
  • reduced attention span
  • irritability
  • disruptiveness
  • aggressiveness

Anecdotal experience suggests that clobazam (Frisium) may have fewer adverse effects than does clonazepam (Klonopin), with less impairment of attention, less mood disturbance, and diminished drooling. One study noted no difference in cognitive impairment among patients receiving clobazam and those receiving carbamazepine.24

Special care should be taken in withdrawing benzodiazepines, as delirium, psychosis, and withdrawal seizures have been reported with excessively rapid withdrawal of these drugs.25

Adapted from: Ettinger AB, Barr WB, and Solomon SP. Psychotropic properties of antiepileptic drugs in patients with developmental disabilities. In: Devinsky O and Westbrook LE, eds. Epilepsy and Developmental Disabilities. Boston: Butterworth-Heinemann; 2001;219–230. With permission from Elsevier (www.elsevier.com).

Authored By: 
Sanford P. Solomon MD
William B. Barr MD
Alan B. Ettinger MD
I<
Reviewed By: 
Steven C. Schachter MD
on: 
Thursday, April 1, 2004