The acute effects of low-dose
clonazepam on seizure frequency in children with
epilepsy was evaluated. In an open study, 19 children with
epilepsy (15 generalized and four partial) were examined during hospitalization with recordings of
seizures by trained personnel.
Seizures were counted during two 24-hour periods: before and after a single
intramuscular injection of
clonazepam 0.01-0.04 mg/kg
body weight. Plasma concentrations of
clonazepam were determined. The median number of
seizures in all children on control days was 22 (range = 1-180) and, on days after low-dose
clonazepam, the median was 6 (range = 0-73). The relative changes demonstrated a median of -70% (range from -100% to + 43%). A significant reduction of
seizures (P = 0.0031) at median maximal plasma levels of
clonazepam of 23 nmol/L (range = 11-41 nmol/L) was found. Thus in this study of the acute effects of a low-dose level of
clonazepam on seizure frequency a significant reduction was found at plasma levels below those usually recommended. Inhibition of seizure activity seems to be achieved already at low plasma levels of
clonazepam. These results suggest to start treatment at low doses of
clonazepam and evaluate the individual effect carefully during dose escalation aiming at lowest possible dose with
therapeutic effect.