Abstracts

Rationale: Refractory epilepsy is a challenging diagnosis, and accounts for approximately one third of patients with epilepsy. In addition to the financial burden, refractory epilepsy is a direct cause for developmental disability, risk for injury, as well as other neurocognetive disorders. Improved seizure control in this group of patients mayreduce co morbidities in this population . Multiple pharmacological and non-pharmacological therapies have been studied for treatment of refractory epilepsy. The ketogenic diet (KGD) has been a well established and effective treatment for refractory epilepsy. Clobazam is a benzodiazepine recently approved by the Food and Drug Administration (FDA) in the United States, and has been proven effective in controlling seizures. This project attempts to study the combined efficacy of both KGD and clobazam in children with refractory epilepsy.Methods: This is a retrospective chart review study at a tertiary level 4 pediatric epilepsy center, studying the efficacy of the combined treatment of KGD and Clobazam. Patients who have refractory epilepsy,are being treated with KGD, and have failed to respond to a benzodiazepine, These patients were switched from the original benzodiazepine to Clobazam with a target dose of 0.3-1.5 mg/kg/day divided twice daily. Outcome was analyzed and divided into the following groups: more than 50% (GroupA), less than 50% (Group B), and those who have no change in their seizure control (Group C).Results: In our database, we have 150 patients who are on the ketogenic diet, with 20 of them found to have been switched from a benzodiazepine to Clobazam. The patients age ranged from 1.92 to 12 years old, with mean age 4.9 years. 11 (55%) boys and 9 (45%) girls. 15 (75%) patients were in group A, 1 (5%) was in group B, and 4 (20%) were in group C.Conclusions: Clobazam and ketogenic treatment have a potentially synergistic effect in patients with refractory epilepsy. Despite failing to respond to other benzodiazepines, patients on ketogenic diet, appear to have a better response to clobazam, with 75% of the patients in our study having more than 50% reduction in seizures.