‘Using the “benzodiazepine switch” in difficult childhood epilepsy’

‘Using the ‘‘benzodiazepine switch’’ in difficult childhood epilepsy’ SIR–The David Lewis Centre in Cheshire, UK is a residential centre for adults and children with severe epilepsies. Many of the children have frequent and prolonged convulsive and non-convulsive seizures. Over the years, a number of treatments have evolved which have been useful but which have not been widely used elsewhere, e.g. the use of chloral hydrate as rescue medication, the use of buccal diazepam for prolonged seizures, and the ‘benzodiazepine switch’. Many clinicians avoid using benzodiazepines for childhood epilepsy because of the well-known undesirable side effects and problems with tolerance. However, for some children with catastrophic epilepsies benzodiazepines are indispensable, allowing a degree of seizure control and improved quality of life when everything else has failed. There may be a significant beneficial response to the introduction of a benzodiazepine, which declines to baseline within weeks or months. For some of these children, rather than the usual slow weaning from one benzodiazepine and cautious introduction of another, we have used ‘the benzodiazepine switch’ – the direct substitution of one benzodiazepine with an equivalent dose of another. This technique has not previously been described, to our knowledge, and the aim of this report is to document its use in a small number of children at the David Lewis Centre.