Abstracts

Rationale: About 20 per 100,000 children have convulsive status epilepticus every year. The International League Against Epilepsy (ILAE) recommends that treatment of continuous convulsive seizures start at five minutes. Seizures occurring in clusters also require acute treatment, as these repetitive seizures can lead to status epilepticus.  Benzodiazepines are of the first line treatment for prolonged and recurrent seizures. There is Level A evidence for the use of intramuscular (IM) midazolam, intravenous (IV) lorazepam, or IV diazepam if a seizure lasts at least five minutes.  Level B evidence exists for per rectum (PR) diazepam, intranasal (IN) midazolam, or buccal midazolam for use at home or in community setting. The US Food and Drug Administration (FDA) approved the usage of PR diazepam (Diastat©) in 1997 for acute repetitive seizures. The use of IN administration of the IV preparation of midazolam (IN midazolam) as an abortive seizure medication has increased in the last years.  Recently, our institution utilized prefilled syringes of midazolam that likely decreased time and improved ease and comfort of use.  Our current study was designed to further analyze this relationship and if any impact on healthcare utilization was present. Methods: Our study is prospective cohort design using the electronic medical record and a survey created in REDCap at a large academic tertiary children’s medical center.  Subjects were patients with epilepsy prescribed IN midazolam, PR diazepam, or both. We analyzed the number of ED visits, utilization of ambulance services, urgent care visits, and unplanned hospitalizations. We also collected information regarding seizure types, co-morbidities, prescription practices and insurance type.  We collected survey information on the comfort, ease of use, and time of administration for patients receiving one or both abortive seizure medications. Results: A survey to patients and/or their caregivers evaluating comfort, satisfaction, and barriers to administration for each product utilizing a Likert scale was created.  For patients and/or caregivers who received a prescription and used either product in the past, we administered a separate survey and plan on administering a survey comparing comfort, satisfaction, and barriers to the medication received previously.  For patients and/or caregivers who have received both products in the past, we will survey use of each medication.  Comfort and estimated time for preparation and administration will be evaluated. A total of 100 patient caregivers have completed the survey with healthcare utilization information collected. Patients prescribed IN midazolam were on average older than those prescribed PR diazepam.  Analysis on ED visits and hospitalizations is ongoing.  Survey answers are currently being analyzed on 100 patients with the goal of enrolling 250 patients.   Conclusions: The results are significant because they further substantiate the cost-effective benefits of prescribing IN midazolam as compared to PR diazepam since several aspects of healthcare utilization were decreased in the group of patients using IN midazolam.  In addition, further analysis on comfort, ease of use, and time of administration will be reviewed.   Funding: This work was supported by an investigator initiated research grant by Upsher-Smith.