Benzodiazepines in the treatment of epilepsy in people with intellectual disability.
Benzodiazepines work for acute seizures in ID but tolerance limits daily use—reserve for emergencies.
01Research in Context
What this study did
Isojärvi et al. (1998) wrote a narrative review about benzodiazepines for epilepsy in people with intellectual disability.
They looked at published papers and clinical experience. They asked: when do these drugs help, and when do they hurt?
What they found
The review says benzodiazepines stop acute seizures fast. They are good rescue meds.
Daily use is tricky. People build tolerance. Sedation can slow learning and daily living skills.
How this fits with other research
Alvarez et al. (1998) covers all seizure drugs in the same year and population. It lists benzodiazepines as rescue only, matching this paper.
Alvarez (1998) warns that phenobarbital also calms seizures but hurts behavior. Both papers push clinicians away from daily sedatives.
Bennett et al. (1998) shows zonisamide cuts seizures less in kids with ID than in typical kids. Together the papers signal: pick drugs that spare cognition, use fast-acting benzodiazepines only for emergencies.
Why it matters
If you support clients with ID and epilepsy, keep a benzodiazepine rescue plan on file. Pair it with data sheets that track seizure time, drug given, and recovery. Avoid scheduling these drugs every day unless a neurologist insists. Watch for extra drowsiness that could cut teaching time. Share the sedation data with families and nurses when you review behavior plans.
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02At a glance
03Original abstract
All the benzodiazepines (BZDs) in clinical use have the capacity to promote the binding of the major inhibitory neurotransmitter, gamma-amino-butyric acid (GABA), to sub-types of GABA receptors which exist as multi-subunit ligand-gated chloride channels. Thus, the BZDs facilitate the actions of GABA in the brain. The BZDs in use as antiepileptic drugs are diazepam, clonazepam, clobazam, nitrazepam, and lately, also lorazepam and midazolam as emergency therapy. The BZDs have a wide-spectrum of proven clinical efficacy in the prevention of different kind of seizures. Clonazepam and clobazam, as well as nitrazepam in some cases, can be useful as an adjunct treatment in refractory epilepsies. However, the clinical use of BZDs for the prophylactic treatment of epilepsy is associated with two major problems which have limited the long-term use of these drugs: the potential for side-effects, especially sedative effects, and the high risk of development of tolerance. Despite the limitations of BZDs in the prophylactic treatment of epilepsies, these drugs play a prominent role in clinical practice in the emergency management of acute seizures and status epilepticus. Diazepam, clonazepam and lorazepam are all considered first-line agents in the emergency management of acute seizures and status epilepticus. Furthermore, the value of midazolam as an emergency therapy in epilepsy has been increasingly recognized in recent years.
Journal of intellectual disability research : JIDR, 1998 · doi:n/a