Excellent results with clorazepate in recalcitrant childhood epilepsies

Eleven children with severe incapacitating generalized seizures were treated with sodium valproate and clorazepate and responded with a marked decrease in seizure frequency. Three children received clorazepate alone, either because of valproate toxicity or because of parental concern over side effects. These children, 5 males and 6 females, ranged in age from 3 to 17 years. They manifested normal to severely retarded intelligence. Although valproate levels were in the therapeutic range, seizure control was inadequate. When clorazepate was added to valproate therapy a marked reduction in seizure frequency occurred within 24 hours and became optimal within 48 to 72 hours. Side effects were minimal with the exception of a nocturnal generalized tonic-clonic seizure in a single patient. Three children were withdrawn from therapy after a year because of recurrent seizures. One patient was restarted on therapy after 6 months and seizure control improved. Clorazepate may be a useful adjunct in the treatment of primary generalized seizures in children.