The use of diazepam and clonazepam in epilepsy

This article reviews the pharmacokinetics, efficacy, and tolerability of diazepam (DZP) and clonazepam (CZP) in the treatment of epilepsy, with special emphasis on the management of acute seizures and status epilepticus. In these conditions, i.v. DZP and CZP are first-line agents, resulting in rapid and lasting control in 70-85% of cases. However, the response rate depends largely on the type of epilepsy in epileptics or the underlying cause of seizures in nonepileptic patients. Because of the rapid redistribution pattern of these antiepileptic drags (AEDs) from the brain, co-administration of a long-acting drug is often required. In contrast, continuous infusion of DZP and CZP is no longer generally recommended. Rectal DZP instillation is a valuable alternative for immediate treatment at home for serial seizures and prophylaxis of febrile seizures. The side effects of i.v. DZP and CZP include cardiorespiratory depression, sedation, and paradoxical effects such as precipitation of tonic status epilepticus in Lennox-Gastaut syndrome. Although both AEDs are currently employed for the management of acute seizures, only CZP is also used for oral treatment of chronic epilepsy, especially with refractory absence, myoclonic, atonic, and partial seizures. Side effects and the development of tolerance, however, limit the usefulness of CZP for chronic treatment.