Abstracts

The safety and efficacy of diazepam rectal gel, a portable rescue medication for the at-home treatment of breakthrough seizures, has been demonstrated in patients of various ages with a broad range of seizure types. Despite the benefits that diazepam rectal gel can provide, some physicians and patients may feel wary about its rectal route of administration in the adult population. Rectal delivery modalities are well accepted in the pediatric population. Physicians with negative perceptions of rectally administered medications may convey these feelings to their patients and, in turn, bias patients against trying this option. However, alternate choices for emergency seizure treatment[mdash]emergency department (ED) visits and intravenous/intramuscular injections[mdash]present other challenges for the patient. Visits to the ED are time consuming and costly. Use of needles with an actively convulsing patient is inherently hazardous. However, patients transported by ED ambulance usually have intravenous access established as part of the emergency protocol. Needle phobia is a frequent concern for many outpatients. A study was conducted with a survey to assess patients[rsquo] fear of treatment with needles versus rectal administration of medication and other quality of life factors pertinent to patients with epilepsy. A multiquestion survey was administered to patients with epilepsy concerning preferences and concerns about rectal versus intravenous administration of medications. Information was also sought regarding ED visits and preferences for at-home treatment or ED visits for breakthrough seizures. Other quality of life information was obtained using the Quality of Life in Epilepsy-10 (QOLIE-10) Survey A pilot study of 12 patients with seizure exacerbation or prolonged seizures completed the survey. All patients in this study preferred at-home management of breakthrough seizures to treatment in the ED, which is often time consuming and costly. In addition, these patients did not view rectally administered medication as a barrier to use. In fact, it was preferred to receiving a needlestick, which would be required for establishing IV access. Additional patients will be surveyed to extend these results to a larger sample. These results indicate that patients with epilepsy view rectal administration positively and prefer this route of administration in the outpatient setting to needlesticks. (Supported by Xcel Pharmaceuticals)