Abstracts

Status epilepticus remains a medical emergency. Deinstitutionalisation and inclusion means people with epilepsy are more likly to have seizures in public. For 2 years we have trialled the use of intranasal midazolam (INM) to manage prolonged seizures in the community. The training package and protocols developed will be described. Evaluation of parent/carer preferences and perceptions of effectiveness with the use of both rectal valium (RD) and INM will be reported. A protocol was developed to trial INM managing prolonged seizures in the community, initially in educational settings. Incorporating a formal seizure management training package, it was soon adopted by adult services in the community, parents and carers. Dose 0.2-0.3 mg/kg. The protocol specified INM would not be given in the community if the person had not safely had a previous dose of midazolam by any route. Plastic 5mg/1ml ampoules only, as drops could be administered directly into the nostrils from the inverted ampoule. An initial survey was distributed to parents and carers to determine acceptance of the use of INM, and perceived effectiveness of both RD and INM. Results of a more comprehensive evaluation will be available before the Annual Meting. Over 100 children and adults have now had prolonged seizures successfully managed with INM. In an initial survey of parents and carers trained to give INM, 37 had actually administered INM. Of 23 who had administered both RD and INM to manage prolonged seizures, 78.4% considered INM very effectice, compared with 39.1% for RD. Perceptions of time to take effect, within 2 minutes (32.4% INM, 8.7% RD). More than 10 minutes (17.4% RD, 0 INM). Preference, 74% INM, 4% RD, 22% either. Reasons given for preference for INM were ease of administration, and less intrusive. RD and INM must be administered with caution, especially in the community. Status epilepticus carries significant morbidity not controlled within 30 minutes of onset. Even if access to ambulance services is fairly prompt, there is no guarantee an ambulance will arrive in time to control the seizure within 30 minutes, so relying on ambulance support alone may result in morbidity. There are also cost benefits. In our opinion, INM is a safe means of controlling prolonged seizures, providing the safeguards we have developed are followed - training in first aid and seizure management, a test dose before giving INM in the community, only using a 5mg in 1 ml plastic ampoule, and having the medical order clearly documented for all to follow.