Seizure after cessation of Benzodiazepines


Benzodiazepines are central nervous system agents that are used in many different ways. It is used as sedatives, anxiolytics, hypnotics, anticonvulsant and as muscle relaxant. The following are short list of benzo commonly used in the hospital:
1. Aprazolam(xanax)- anxiolytic
2. Clonazepam(Klonopin)- anxiolytic, anticonvulsant
3. Diazepam(valium)- anxiolytic, anti convulsant, muscle relaxant
4. Lorazepam(ativan)- anxiolytic, anticonvulsant
5. Midazolam(versed)- hypnotics, anticonvulsant
6. Temazepam(Restoril)-hypnotic

How Benzo Works?
It works by enhancing/increasing GABA’s action potential.The neurons of the brain become tamed and resistant to excitation resulting to a calm and relaxed neuron. With Benzodiazepines, the anxious calms down, muscles relaxes during convulsions as neuron of the brain relaxes.

What is the Role of GABA( gamma- aminubutyric acid) neurotransmitter?
GABA is the primary inhibitory neurotransmitter. It works in the neuronal synapses of the brain to refine and tune up neurotransmission by inhibiting the action potential of neurons thereby causing the neuron less excitatory or resistant to excitation.

When can a person become dependent to Benzo?
Studies show that use of Benzo for more than 4 weeks makes a person physically and psychologically dependent to benzo. Being in the body system for 4 weeks it had suppressed the action potential of neurons in the brain long enough that it took over the place of the natural GABA inhibitory action.

What Happens when a Person becomes Benzodiazepine dependent?
A person becomes dependent when the body is unable to adjust once benzo is withdrawn. When the level of benzo in the system is decreased the neuron becomes excited again as evidenced by tremors, twitching and insomnia. The person experiencing this withdrawal symptoms becomes afraid as a result takes benzo more often and even increase the dose to achieve its maximum effect. An evidence that the body became dependent to benzo this in turn affects the thinking ability(psychologically).

What are the Withdrawal Symptoms of Benzodiazepines?
The physical signs- twitching, tremors, shakiness, muscle aches and pain then …SEIZURE/CONVULSIONS.( when benzo is not taken for more than 8 days.. SEIZURE or convulsion in inevitable.)
The psychological symptom- increased anxiety, and insomnia.

Conclusion: Benzodiazepines are CNS depressant, physical and psychological dependence develops when used longer than 4 weeks. Individuals who attempts to cut benzo are usually unsuccessful because of the withdrawal symptoms and for this reason continue to use and even increase dosage to suppress withdrawal syndrome.

Case: among pt’s home medication list was clonazepam, pt takes a total of 1.5 mg daily at home. During hospital admission pt developed encephalopathy, delirium and decreased responsiveness. Clonazepam was discontinued. Pt recovered, on the 9th day without benzo pt develops increased tremors and shakiness. Low dose of Clonazepam resumed. !0th day pt had a seizure and was put on Depakote.

Reference: Benzodiazepine dependence by Wikipedia

I hope the changes made the subject much clearer for readers to understand better.


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