Use of New Intranasal Benzodiazepines at a Typical Adult Epilepsy Center
Abstract number :
2.114
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2021
Submission ID :
1825533
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:44 AM
Authors :
Caralynn Li, DO - University of South Florida; Natasha Llanes, MD - University of South Florida; Ushtar Amin, MD - University of South Florida; Stephanie MacIver, MD - University of South Florida; Angelica Rivera Cruz, MD - University of South Florida; Melissa Polzer, RN - University of South Florida; Selim Benbadis, MD - University of South Florida
Rationale: Patients with epilepsy often experience acute repetitive seizures or seizure clusters. Until recently, the only non-oral rescue benzodiazepine was a diazepam rectal gel (Diastat). However, there are now two intranasal benzodiazepines that are FDA-approved: midazolam (Nayzilam) and diazepam (Valtoco). The objective of this study was to review the use of these new intranasal rescue benzodiazepines at a typical adult epilepsy center.
Methods: We retrospectively reviewed patients who were prescribed either intranasal midazolam or intranasal diazepam between April 2020 and April 2021 by an adult epileptologist. Data were collected through chart review and by telephone calls to either the patient or the caregiver.
Results: We identified 77 total patients. There were 38 patients in the midazolam group and 39 patients in the diazepam group. Combined, the epilepsy diagnosis was 31 (40%) patients with Lennox-Gastaut syndrome, 27 (35%) with focal epilepsy, 7 (9%) with idiopathic generalized epilepsy, 2 (3%) with Dravet syndrome and 10 (13%) with an unclear diagnosis. Combined, the most common seizure types were generalized motor seizures in 67 (87%) patients and focal motor seizures in 19 (25%) patients.
In the midazolam group, 21 (55%) patients had used the nasal spray at the time of data collection. Of these 21 patients, 11 (52%) reported cessation of seizures after the first dose, 6 (29%) reported cessation after either the first or second dose, 1 (5%) reported a mixed response and 3 (14%) reported no clinical improvement (Figure 1). Regarding the overall satisfaction score, 17 (81%) were either satisfied or very satisfied with the results, 1 (5%) gave a neutral score, and 3 (14%) were very dissatisfied (Figure 2). Adverse effects involved either fatigue in 5 (24%) patients or nasal discomfort in 2 (10%) patients.
In the diazepam group, 24 (62%) patients had used the nasal spray at the time of data collection. Of these 24 patients, 20 (83%) reported cessation of seizures after the first dose, 3 (13%) reported a mixed response and 1 (4%) reported no clinical improvement (Figure1). Five (20%) patients reported use of the second dose but did not wait the recommended 4-hour period. Regarding the overall satisfaction score, 19 (79%) were either satisfied or very satisfied with the results, 3 (13%) gave a neutral score, and 2 (8%) were very dissatisfied (Figure 2). Adverse effects involved fatigue in 5 (21%) patients, headache in 2 (8%), nasal discomfort in 1 (4%), and dizziness in 1 (4%).
Seventeen (45%) patients in the midazolam group and 15 (38%) patients in the diazepam group had not yet used the medication at the time of data collection. These patients reported that they were either seizure free or did not experience seizure clusters requiring rescue therapy.
Conclusions: The use of the two new intranasal benzodiazepines was roughly divided equally. Slightly more than half of the patients who were prescribed the medication had used it. The overall satisfaction of the two medications was comparable, with 81% and 79% of the patients who were either satisfied or very satisfied with the results.
Funding: Please list any funding that was received in support of this abstract.: None.
Clinical Epilepsy