Benzodiazepines in the treatment of epilepsy in people with intellectual disability

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 li gand-gated chloride channels. Thus, the BZDs facilitate the actions of GABA in the brain. The BZDs in use as antiepileptic drugs are diazepam, clonaze pam, clobazam, nitrazepam, and lately, also lorazepam and midazolam as emer gency 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 prophylact ic treatment of epilepsy is associated with two major problems which have l imited the long-term use of these drugs: the potential for side-effects, es pecially sedative effects, and the high risk of development of tolerance. D espite the limitations of BZDs in the prophylactic treatment of epilepsies, these drugs play a prominent role in clinical practice in the emergency ma nagement 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 midazo lam as an emergency therapy in epilepsy has been increasingly recognized in recent years.