![]() Here we report a 7-year-old boy who was diagnosed with refractory complex partial epilepsy, in which clonazepam was tried after multiple medications and failed to control this type of seizure. 6, 7 Moreover, increased total sleep time, sleep efficiency, sleep stage 2, and slow-wave sleep have been shown in patients receiving clonazepam treatment. 5 Clonazepam could be useful in children with refractory epilepsy because it may reduce the frequency of seizures, although a high frequency of side effects such as hypotonia, hypersalivation, and bronchial hypersecretion was observed. Benzodiazepines can be used in refractory epilepsy such as partial, idiopathic generalized, and symptomatic/cryptogenic generalized epilepsy. ![]() 3 According to Raspall-Chaure et al., 4 clonazepam is selected as a first-line drug in severe myoclonic epilepsy in infancy, epilepsy with continuous spike wave of slow sleep, myoclonic-astatic epilepsy, and infantile spasms, and is a second-line drug for juvenile myoclonic epilepsy and Lennox–Gastaut syndrome. 1, 2 It is effective in myoclonic and generalized absence seizures rather than generalized tonic–clonic seizures, which can actually be exacerbated therefore, clonazepam is rarely used as a primary antiepileptic drug, although it still has a role as an adjunctive therapy. As a result, clonazepam was stopped 3 days later.Ĭlonazepam is a potent benzodiazepine compound that was approved as an antiepileptic drug by the U.S. The seizures became more frequent during sleep as recorded by nocturnal polysomnography. To our surprise, the boy’s symptoms did not improve on the contrary, they got worse. Finally, refractory complex partial epilepsy was diagnosed and clonazepam was added. An examination using the WISC was also normal. In addition, CSF examination, head CT scans, head MRI scans, head MR angiography scans, and examinations for toxoplasma, rubella virus, cytomegalovirus, and herpes virus were all normal. On the patient’s admission to our hospital, we found no evidence of acidosis or serum electrolyte imbalance. ![]() However, different antiepileptic drug therapies, including lamotrigine, carbamazepine, oxcarbazepine, levetiracetam, and gabapentin, were not effective for him for nearly 4 years. He visited many different hospitals, and he was diagnosed with frontal lobe epilepsy at age 3 years and 10 months. Moreover, the boy had no family history of seizures and no history of craniocerebral trauma, intoxication, encephalitis, meningitis, or febrile seizures.Īt age 3 years and 3 months, the boy was diagnosed with epilepsy and antiepileptic drugs were started. His intelligence and physical development were both normal. The patient was born after a full-term pregnancy without any complications and developed normally until the first seizure. EEG Recorded on Hospital Admission at Age 3 Years 3 Months Shows Focal Seizure Activity Arising From the Frontal Region aĪDiffuse spike, wave complexes, and multifocal spikes over the frontotemporal region during the intervals of the seizures were seen. The EEG showed that the origin of the seizures was from the frontal region ( Figure 1).įIGURE 1. During this time, the boy had a normal temperature. During the seizures, the boy had no response to voice commands, and he had conjugate eye movements, a folded right fist, and an unbent right leg, which lasted nearly 20 seconds. At age 3 years and 3 months, he was admitted to a local hospital for an EEG, and there were four seizures during the 4-hour sleep monitoring. The patient resumed normal activity with no recollection of the event, and he had no seizures for 1 month. His head deviated to the right side with a gelastic seizure for no more than 20 seconds, and he could not complete his parents’ commands such as picking up the apples on the table and had no response to this request. The patient experienced his first seizure at age 3 years and 2 months, after his temperature was controlled during a fever. The seizures, which lasted no more than 1 minute, occurred up to 39 times per day. A 7-year-old boy was referred to our hospital with the chief complaint of frequent motor seizures for >3 years, which affected his body on the right side during sleep and were followed by gelastic seizures.
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