Abstracts

A widely prescribed rescue medication for patients with clustering of seizures or for prolonged attacks is rectal diazepam. For the adolescent, adult, or his caregiver, this route can be sufficiently embarrassing or unwieldy to limit its usefulness. Procedural issues have been raised in the school environment where staff may be expected to give a rectal dose to a student. Clearly other methods of delivery are needed. We have used diazepam concentrated oral solution as a rescue medicine. The oral solution contains 5 mg of diazepam for each ml of fluid and is administered with a calibrated dropper. As salivary production often increases with stimulation during seizure activity, an extra 1 to 2 ml of medication should be inconsequential for clinical aspiration. We prospectively followed 12 patients (7 women, 5 men, ages 14 - 63) with intractable seizures who used concentrated oral diazepam at least twice as a rescue medicine. Patients and caregivers were instructed to instill the fluid between cheek and gum for seizure clusters or for seizures lasting longer than 5 minutes. Patients and caregivers were asked to report their experience in using the concentrate. Use of oral concentrate shortened or ended the seizure or seizure cluster in all patients and no patient had clinically evident aspiration. The patients who had difficulty with rectal diazepam were treated successfully with the oral route. Four patients self-administered the oral diazepam for clustering of partial seizures; the others had medication given by a caregiver. Ten of the twelve patients to some extent swallowed the medication rather than have it absorbed buccally. Two patients had the medicine discontinued because of overuse for partial seizures and one family was counseled about its proper use, but no patient abused it for behavioral reasons. Oral administration had a later clinical onset of action than the rectal route but was used sooner during a seizure episode often forestalling seizure generalization. In this limited series of patients concentrated oral diazepam solution was used safely and effectively for adolescent and adult patients requiring rescue medication for seizures. No patient developed aspiration symptoms or required hospitalization for aspiration and in most instances seizures were satisfactorily treated. Oral concentrated diazepam solution may be a viable alternative to rectal administration. (Supported by The Bob and Vivian Smith Foundation)