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December 6, 1976

Chlorazepate in Temporal Lobe Epilepsy

Author Affiliations

Boston University School of Medicine and Boston Veterans Administration Hospital Boston

JAMA. 1976;236(23):2603. doi:10.1001/jama.1976.03270240013006

To the Editor.—  Clorazepate dipotassium (Tranxene) is a new benzodiazepine derivative that is generally available for use in the symptomatic relief of anxiety.1 Preliminary studies2 have indicated a possible role for clorazepate in the treatment of certain patients with epilepsy. In further studies of this compound in epileptic patients, we have observed a serious but reversible side effect which deserves comment.Of 17 patients with temporal lobe epilepsy who received clorazepate dipotassium in doses of more than 22.5 mg/day, eight exhibited personality changes characterized by depression, irritability, and aggressive behavior. Four of the eight became very hostile and "difficult to live with," with overt, violent outbursts. None had ever had a history of aberrant behavior. It is of interest that six of these eight patients were receiving, in addition to clorazepate, primidone alone (one case), primidone in combination with phenytoin (three cases), and primidone in combination with phenobarbital