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Is clobazam monotherapy effective and safe in people with focal or generalized seizures? A Cochrane Review summary with commentary

BACKGROUND Epilepsy is one of the most common and disabling neurological disorders, ranking fifth globally in terms of disability-adjusted life years. It is characterized by abnormal electrical brain activity that might cause seizures. Seizures can be focal (limited to part of one cerebral hemisphere) or generalized. Many disabling health conditions are associated with epilepsy. For example, one in three children with cerebral palsy develops seizures, and stroke is the most common cause of seizures in older people. The guidelines from the National Institute for Health and Care Excellence (NICE) recommend pharmacological treatment for epilepsy in children and adults as first-line treatment. Control seizures are key, as these represent an additional challenge to the rehabilitation process. Effective drug treatment can rapidly lead to long-term remission in up to 70% of people with epilepsy. However, in children with cerebral palsy and epilepsy, remission can take more than 10 years after the epilepsy onset, possibly due to the slower maturation of inhibitory mechanisms. Carbamazepine or lamotrigine are recommended for newly diagnosed focal seizures and sodium valproate for generalized seizures. NICE guidelines also recommend individualizing the treatment according to seizure type, epilepsy syndrome, comedication and comorbidity, age, and patients’ preferences whenever possible. Therefore, it is important to have high quality evidence regarding effectiveness and adverse effects in order to inform treatment choices. Clobazam is commonly used as an anti-seizure medication either as monotherapy or as an add-on treatment. In monotherapy, it has been shown to have similar efficacy to phenytoin or carbamazepine in the treatment of previously untreated children with focal seizures. It appears to have fewer side effects than other benzodiazepines.