Treatment of Out-of-Hospital Status Epilepticus with Diazepam Rectal Gel (Diastat ?)
Abstract number :
3.168
Submission category :
Year :
2000
Submission ID :
1768
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Brian J Fitzgerald, Anthony J Okos, John W Miller, Univ of Washington, Seattle, WA.
RATIONALE: To determine the effectiveness and safety of diazepam rectal gel in out-of-hospital treatment of status epilepticus. Hospital IV protocols are difficult to follow in our developmentally disabled residents due to their lack of cooperation, muscular contractures and atrophy. METHODS: At our large long-term care facility, nurses initiated a treatment attempt for status epilepticus in adults after 10 minutes of continuous generalized tonic-clonic seizure activity. From 5/1/96 to 5/1/98 this treatment consisted of 4 mg of IV lorazepam; from 5/1/98 to 5/1/99, for the same individuals, it consisted of 15 to 20 mg of diazepam rectal gel (Diastat ?). The following data were retrospectively collected: time of medication administration, time to cessation of seizure, time of total seizure and adverse drug reactions. Data included all individuals having at least one treatment attempt of both diazepam and lorazepam. RESULTS: There were 107 treatment attempts including multiple attempts of both medications for each individual. Diazepam was administered in all 36 attempts whereas lorazepam in 21 out of 71 attempts. In the diazepam treatment attempts, 4 seizures were longer than 30 minutes whereas in the lorazepam attempts 20 seizures exceeded 30 minutes. The time to administration of diazepam (12 1) was significantly (p < 0.05) shorter than lorazepam (20 3 minutes). Diazepam's time to cessation of seizure was 7 1 whereas lorazepam's time was 4 1 minutes. There was a significant (p< 0.05) 27 % reduction of total seizure time for diazepam (18 1) as compared to lorazepam (25 3 minutes). One episode of transient hypotension resolved without sequelae for both treatments. CONCLUSIONS: In patient population and setting, IV lorazepam is usually not a suitable treatment for status epilepticus because of the difficulty of prompt IV access. Diazepam rectal gel was administered more quickly and reliably, reducing seizure duration, potential neuronal injury and other potential complications. Diazepam rectal gel is a more effective and safer substitute for IV lorazepam in out-of-hospital treatment of status epilepticus.