Abstracts

RATIONALE: Rectal diazepam gel(Diastat) is increasingly being used for the treatment of childhood seizures beyond the initial indication of acute repetitive seizures. We are conducting a prospective study on the impact of the availability of rectal diazepam at home on the need for emergency department (ED) visits and on the family's quality of life. METHODS: Eligible subjects are families of children 12 years of age and under who are prescibed rectal diazepam gel for home use for the first time, whether or not they have been given it in the hospital. Families were instructed in use of rectal diazepam gel. Quality of life questionnaires were administered at study entry and at 6 months. Informed consent was obtained in all cases. RESULTS: To date, 25 families have been enrolled with a mean follow-up of 5.6 months. Of the 25, 12 (48%) had febrile seizures, 9 of whom were sent home on no other medications. The remaining 13 (52%) included 3 with a first unprovoked seizure and 10 with epilepsy. Six children (24%) had episodes of status epilepticus including 4 with recurrent status. Nine children (36%) met the criteria for acute repetitive seizures. As of May 1, 2000, 5 (20%) families have used the rectal diazepam gel, 3 of whom have used it more than once. Rectal diazepam gel was used at home in 5 (20%) cases. In the more than 10 uses of the drug, no ED visits were needed. One family ran out of medicine after 2 uses and the third event did require an ED visit. Use or nonuse of the drug was deemed appropriate by the clinician in all cases. Family satisfaction with having rectal diazepam at home was high even in those who did not need to use it. In one case, the mother was too nervous to use it but another family member gave it during the seizure. More subjects are currently being recruited and followed. CONCLUSIONS: Use of rectal diazepam gel reduces the need for emergency department visits in patients with epilepsy who experience prolonged or repetitive seizures and offers families a measure of feeling secure. It also allows families and clinicians to avoid the need for daily antiepileptic drug therapy in children with rare but potentially prolonged seizures. [Supported by an unrestricted educational grant from Elan Pharma]