An overview of Benzodiazepines in seizure management

Abstract

Benzodiazepines (BZDs) were first synthesized in 1933 but were not introduced for the treatment of epilepsy until 1965, when Henry Gastaut treated status epilepticus with intravenous diazepam. Since then, BZDs have been widely used in the management of epilepsy in both children and adults. At present, seven different BZDs are used in various countries as antiepileptic drugs. Because of their high lipophilicity, rapid brain penetration, and brain receptor binding, BZDs administered either i.v. or rectally are often first-line agents for acute seizure management. Although they have also been used for epilepsy prophylaxis, chronic treatment with BZDs is sometimes hampered by their propensity to produce sedation and other side effects, including development of tolerance to their anticonvulsant effects. Nevertheless, all patients with a devastating seizure disorder should have the opportunity for prophylaxis with a BZD. Whether or not treatment continues will depend on careful evaluation of the therapeutic response, toxicity, and the development of tolerance.