Response to clobazam in continuous spike‐wave during sleep. (23rd November 2017) - Vega, Clemente
Abstract : Aim: To evaluate the efficacy of clobazam treatment in reducing epileptiform discharges and modifying neuropsychological function in continuous spike‐wave during slow wave sleep. Method: We performed a prospective clinical trial in patients with continuous spike‐wave during sleep aged 4 to 10 years. Patients underwent neuropsychological assessment and overnight electroencephalographic monitoring before treatment, and subsequent repeat assessment and overnight electroencephalographic monitoring 3 months after treatment. Treatment consisted of 1mg/kg clobazam up to a maximum dose of 30mg during the first night, followed by 0.5mg/kg nightly for 3 months. Results: Nine patients completed the study and had pre‐ and post‐neuropsychological evaluation. There was a qualitative reduction in median (p25 –p75 ) spike percentage after 3 months (72.2 [68.0–75.8] vs 32.7 [4.7–81.7]). There were no marked changes in median (p25 –p75 ) IQ comparing pre‐ and post‐clobazam treatment (80.0 [74.0–88.0] vs 80.0 [67.0–89.0]). There was a qualitative increase in Verbal IQ (83.0 [69.0–92.0] vs 95.0 [83.0–99.0]) and a qualitative decrease in Non‐verbal IQ (84.0 [74.0–87.0] vs 71.0 [60.0–84.0]). Interpretation: Qualitative improvements in epileptiform activity and cognition occurred in patients treated with clobazam for 3 months and the relationship between epileptiform activity and cognitive outcome should be studied in larger studies. What this paper adds: Verbal IQ in patients with continuous spike‐wave during sleep improved following short‐term treatment with clobazam. Other neuropsychological improvements were observed, but varied by patient. Cognitive improvement was observed despite some worsening of epileptiform discharges. What this paper adds: Verbal IQ in patients with continuous spike‐wave during sleep improved following short‐term treatment with clobazam. Other neuropsychological improvements were observed, but varied by patient. Cognitive improvement was observed despite some worsening of epileptiform discharges. This article is commented on by Varadkar on page220 of this issue. This article's abstract has been translated into Spanish and Portuguese. Follow the links from theabstract to view the translations.