Intermittent clobazam prophylaxis in hot water epilepsy is safe and effective: A prospective study

Purpose: To evaluate the role of intermittent prophylaxis with clobazam in the management of HWE in a long-term prospective study. Material and methods: Two hundred and sixty patients [M:F - 194:66] with HWE were recruited. Patients were divided into: (a) 'HWE alone' (n=198) - received intermittent clobazam prophylaxis, 1-11/2h prior to hot water head bath (group A); (b) 62 patients (20.4%) with 'HWE with spontaneous seizures were treated with continuous AEDs along with intermittent clobazam therapy (group B). Results: Patients (n=198) in group A was followed for mean of 17.6 +/- 10.6 months (range: 3-57). One hundred and forty seven patients (74.2%) had excellent response with complete seizure freedom with clobazam therapy while 12 (6.1%) had >75% reduction in seizure frequency. Remaining 39 (19.7%) required additional standard AEDs along with clobazam and 18 patients among them developed spontaneous/unprovoked seizure at follow up of 6.7 +/- 4.1 months. Forty five patients in group B were seizure free while on continuous AEDs. Conclusions: Intermittent clobazam prophylaxis prior to head water bath might be a preferred mode of treatment of pure HWE. Additional AEDs are required if they have associated non-reflex unprovoked seizure. (C) 2014 Elsevier B.V. All rights reserved.