Editing Benzodiazepine (section)

===Seizures===
{{Further|Seizure}}
[[File:Diazepam 10mg-2ml vial yellow background.jpg|thumb|Diazepam 10mg/2ml vial]]

Prolonged convulsive [[epileptic seizure]]s are a [[medical emergency]] that can usually be dealt with effectively by administering fast-acting benzodiazepines, which are potent [[anticonvulsants]]. In a hospital environment, [[intravenous]] [[clonazepam]], [[lorazepam]], and [[diazepam]] are first-line choices. In the community, intravenous administration is not practical and so [[rectal]] diazepam or [[buccal mucosa|buccal]] [[midazolam]] are used, with a preference for midazolam as its administration is easier and more socially acceptable.<ref name=SIGN70>{{cite web |url=http://sign.ac.uk/pdf/sign70.pdf |title=Diagnosis and management of epilepsy in adults |access-date=5 June 2009 |publisher=Scottish Intercollegiate Guidelines Network |year=2005 |pages=17–19 |archive-url=https://web.archive.org/web/20090126152302/http://sign.ac.uk/pdf/sign70.pdf |archive-date=26 January 2009 |url-status=dead }}</ref><ref name=NICECG020>{{cite book |url=http://www.nice.org.uk/nicemedia/pdf/CG020fullguideline.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://www.nice.org.uk/nicemedia/pdf/CG020fullguideline.pdf |archive-date=9 October 2022 |url-status=live |title=Clinical Guidelines and Evidence Review for the Epilepsies: diagnosis and management in adults and children in primary and secondary care |access-date=2 June 2009 |vauthors=Stokes T, Shaw EJ, Juarez-Garcia A, Camosso-Stefinovic J, Baker R |date=October 2004 |publisher=Royal College of General Practitioners |pages=61, 64–65 | location = London }}</ref>

When benzodiazepines were first introduced, they were enthusiastically adopted for treating all forms of [[epilepsy]]. However, drowsiness and [[drug tolerance|tolerance]] become problems with continued use and none are now considered [[first-line treatment|first-line]] choices for long-term epilepsy therapy.<ref name="pmid19298435">{{cite journal | vauthors = Shorvon SD | title = Drug treatment of epilepsy in the century of the ILAE: the second 50 years, 1959-2009 | journal = Epilepsia | volume = 50 | issue = Suppl 3 | pages = 93–130 | date = March 2009 | pmid = 19298435 | doi = 10.1111/j.1528-1167.2009.02042.x | s2cid = 20445985 | doi-access = free | title-link = doi }}</ref> [[Clobazam]] is widely used by specialist epilepsy clinics worldwide and clonazepam is popular in the Netherlands, Belgium and France.<ref name="pmid19298435"/> Clobazam was approved for use in the United States in 2011. In the UK, both clobazam and clonazepam are second-line choices for treating many forms of epilepsy.<ref name=NICECG020b>{{cite web |url=http://www.nice.org.uk/nicemedia/pdf/CG020fullguideline_appendixB.pdf |title=Clinical Guidelines and Evidence Review for the Epilepsies: diagnosis and management in adults and children in primary and secondary care (Appendix B) |access-date=2 June 2009 |vauthors=Stokes T, Shaw EJ, Juarez-Garcia A, Camosso-Stefinovic J, Baker R |date=October 2004 |publisher=Royal College of General Practitioners |page=432 |location=London |archive-url=https://web.archive.org/web/20111127113914/http://www.nice.org.uk/nicemedia/pdf/CG020fullguideline_appendixB.pdf |archive-date=27 November 2011 |url-status=dead }}</ref> Clobazam also has a useful role for very short-term seizure [[prophylaxis]] and in [[catamenial epilepsy]].<ref name="pmid19298435"/> Discontinuation after long-term use in epilepsy requires additional caution because of the risks of rebound seizures. Therefore, the dose is slowly tapered over a period of up to six months or longer.<ref name=NICECG020/>