(FDA approved in bold)

• Seizure disorders. Used as monotherapy or adjunctive for the treatment of Lennox-Gastaut syndrome, akinetic, myoclonic or absence seizures
  
• Panic disorder, with or without agoraphobia
  
• Periodic leg movements disorder (PLMD)
  
• Restless legs syndrome (RLS)
  
• Tic disorders
  
• Parkinsonian (hypokinetic) dysarthria
  
• Muscle relaxation
  
• Insomnia
  
• Burning mouth syndrome
  
• Generalized anxiety disorder
  
• Schizophrenia (adjunctive)
  
• Acute mania in bipolar disorder

• Benzodiazepines bind to and potentiate the effect of GABA-A receptors, boosting chloride conductance through GABA-regulated channels, and other inhibitory neurotransmitters. There are at least 2 benzodiazepine receptors, 1 of which is associated with sleep mechanisms, the other with memory, sensory and cognitive functions. They act at spinal cord, brainstem, cerebellum, limbic and cortical areas
  
• In petit mal seizures clonazepam suppresses spike and wave discharges, and in motor seizures decreases the frequency, amplitude, duration and spread of discharge

• There is often an immediate effect in treatment of epilepsy, PLMD, RLS, insomnia and panic disorders, but usually weeks are required for optimal dose adjustments and maximal therapeutic benefit

• Seizures – goal is the remission of seizures. Continue as long as effective and well-tolerated. Consider tapering and slowly stopping after 2 years seizure-free, depending on the type of epilepsy
  
• PLMD, RLS, tic disorders – continue to adjust dose to find the lowest dose that produces relief of symptoms with fewest AEs
  
• Anxiety – often used only on a short-term basis. Consider adding an SSRI or SNRI for long-term treatment

• Epilepsy: consider changing to another agent, adding a second agent or referral for epilepsy surgery evaluation
  
• PLMD, RLS: change to or use combination with a dopamine agonist or an AED such as gabapentin or carbamazepine. Rule out iron-deficiency; if obese, weight loss may be helpful

• Epilepsy: often used in combination with other AEDs for optimal control but sedation can increase
  
• PLMD, RLS: dopamine agonists or gabapentin
  
• Anxiety: SSRI or SNRIs. In most cases it is best to avoid combining with other benzodiazepines
  
• Insomnia: may be combined with low-dose tricylic antidepressants (amitriptyline), or tetracyclics (trazodone, mirtazapine)

• None required