Prehospital Treatment of Status Epilepticus (SE) with Diazepam Nasal Spray in Pediatric and Adult Patients with Epilepsy
Eric Segal1, John Stern2, Danielle Becker3, Randa Jarrar4, Tracy Glauser5, Jurriaan Peters6, Emilio Perucca7, Leock Ngo8, Enrique Carrazana9, Adrian Rabinowicz10
1Hackensack University Medical Center, 2University of California Los Angeles, 3Ohio State University Wexner Medical Center, 4Phoenix Children’s Hospital, 5Childrens Hosp Med Ctr Dept of Neuro, 6Boston Children’s Hospital and Harvard Medical School, 7The University of Melbourne, 8Neurelis, Inc., 9Neurelis, Inc.; John A. Burns School of Medicine, University of Hawaii, 10Neurelis, Inc.; Center for Molecular Biology and Biotechnology, Charles E. Schmidt College of Science, Florida Atlantic University
Objective:
Assess prehospital treatment of SE with diazepam nasal spray in patients with epilepsy aged 2-65 years.
Background:
Intranasal immediate-use seizure medications have been recommended as first-line treatment of SE in the community. The International League Against Epilepsy (ILAE) defines tonic-clonic SE and focal SE with impaired consciousness using timepoints t1, when seizures are abnormally prolonged, and t2, when long-term consequences may occur.
Design/Methods:
Data were pooled from patient diaries of 2 long-term safety studies (total 199 patients; 4192 seizure episodes) evaluating diazepam nasal spray for seizure clusters with dosing based on age and weight. Seizures were categorized as generalized or focal. If not captured, the seizure type was inferred post hoc, with some episodes in patients with both types of seizures counted in both generalized and focal categories; some seizures could not be categorized. Seizure types were mapped to the ILAE categories and defined by t1 (treatment >5 minutes after onset for generalized and >10 minutes for focal seizures) and t2 (30 minutes for generalized and 60 minutes for focal seizures). SE episodes were analyzed by time from seizure onset to dose and dose to seizure termination, total seizure duration, and termination time ≤t2.
Results:
Among SE episodes with generalized (n=357 episodes) or focal (n=340 episodes) seizures, median time from onset to dose was 12 and 26 minutes, from dose to seizure termination was 5 and 14 minutes, and total seizure duration was 20 and 50 minutes, respectively. For generalized SE episodes, 63.9% (228/357) terminated ≤t2; 60.3% (205/340) of focal SE episodes terminated ≤t2. In contrast, 20 SE episodes that led to hospitalization/prolonged hospitalization were reported; none were considered related to treatment.
Conclusions:
Prehospital use of diazepam nasal spray in patients aged 2-65 years resulted in rapid termination of SE episodes with generalized and/or focal seizures. Few SE events required hospitalization.
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