1160 EFFECTS OF CLOBAZAM ON SLEEP AND DAYTIME FUNCTION IN PATIENTS WITH EPILEPSY

Abstract

Introduction: Sleep complaints are widely reported from patients with epilepsy, and antiepileptic medications (AED) may affect sleep. While some of the AED effects on sleep have been more extensively studied, to date there are no reports of the effects of clobazam, a novel AED with benzodiazepine properties. We tested the hypothesis that patients with epilepsy will have longer, more consolidated sleep after treatment with clobazam. Methods: In this prospective study, we included epilepsy patients (≥18 years old) who were being considered for treatment of epilepsy with clobazam. Patients with known untreated moderate/severe sleep apnea, or with major circadian rhythm disorders were excluded. Nine patients who started clobazam treatment were tested with a set of subjective sleep measures: Pittsburgh Sleep Quality Inventory (PSQI), Epworth Sleepiness Scale (ESS), Karolinska Sleepiness Scale (KSS), Insomnia Severity Index (ISI), and Quality of Life in Epilepsy (QOLIE) prior to starting the treatment, as well as after achieving a stable clobazam dose. They also completed a week of supportive objective assessment of sleep (actigraphy) before starting therapy and one week after achieving stable dose. Results: Treatment with clonazepam slightly improved sleep quality (PSQI before, 7.3 ± 4.1 vs after, 6.4 ± 2.2) and wake after sleep onset (WASO before, 47.7 ± 18.2 vs after, 46.5 ± 17.0), although these did not reach statistical significance. Nevertheless, a trend was observed for increased total sleep time after treatment (before, 435.5 ± 148.9 minutes vs after, 490.0 ± 80.4; p=0.09). Surprisingly, quality of life, insomnia, and sleepiness measures revealed worse outcomes after treatment (QOLIE before, 25.6 ± 5.7 vs after, 24.8 ± 6.2; ESS before, 6.3 ± 3.7 vs after, 8.9 ± 5.2; KSS before, 5.0 ± 1.6 vs after, 5.4 ± 1.8; ISI before, 10.1 ± 6.2 vs after, 11.2 ± 4.4), although again, these did not reach significance. Conclusion: Preliminary analyses suggest that clobazam may be beneficial for sleep in patients with epilepsy, primarily by increasing total sleep time. However, further analyses in a larger group are needed to clarify the impact of clobazam on daytime sleepiness and well being.