Comparison of Intranasal and Intravenous Diazepam on Status Epilepticus in Stroke Patients: a Retrospective Cohort Study

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2015 Feb 21

PMID 25700327

Citations 7

Authors

Ryota Inokuchi

Naoko Ohashi-Fukuda

Kensuke Nakamura

Tomoki Wada

Masataka Gunshin

Yoichi Kitsuta

Susumu Nakajima

Naoki Yahagi

Affiliations

Soon will be listed here.

Abstract

Administering diazepam intravenously or rectally in an adult with status epilepticus can be difficult and time consuming. The aim of this study was to examine whether intranasal diazepam is an effective alternative to intravenous diazepam when treating status epilepticus. We undertook a retrospective cohort study based on the medical records of 19 stroke patients presenting with status epilepticus to our institution. We measured the time between arrival at the hospital, the intravenous or intranasal administration of diazepam, and the seizure termination. Intranasal diazepam was administered about 9 times faster than intravenous diazepam (1 vs 9.5 minutes, P = 0.001), resulting in about 3-fold reduction in the time to termination of seizure activity after arrival at the hospital (3 minutes compared with 9.5 minutes in the intravenous group, P = 0.030). No adverse effects of intranasal diazepam were evident from the medical records. Intranasal diazepam administration is safer, easier, and quicker than intravenous administration.

Citing Articles

Time Is Brain: Acute Control of Repetitive Seizures and Status Epilepticus Using Alternative Routes of Administration of Benzodiazepines.

Almohaish S, Sandler M, Brophy G J Clin Med. 2021; 10(8).

PMID: 33920722 PMC: 8073514. DOI: 10.3390/jcm10081754.

VALTOCO (Diazepam Nasal Spray) for the Acute Treatment of Intermittent Stereotypic Episodes of Frequent Seizure Activity.

Cornett E, Amarasinghe S, Angelette A, Abubakar T, Kaye A, Kaye A Neurol Int. 2021; 13(1):64-78.

PMID: 33670456 PMC: 7931041. DOI: 10.3390/neurolint13010007.

A Short Review on the Intranasal Delivery of Diazepam for Treating Acute Repetitive Seizures.

Boddu S, Kumari S Pharmaceutics. 2020; 12(12).

PMID: 33265963 PMC: 7761129. DOI: 10.3390/pharmaceutics12121167.

Bioavailability and safety of diazepam intranasal solution compared to oral and rectal diazepam in healthy volunteers.

Hogan R, Gidal B, Koplowitz B, Koplowitz L, Lowenthal R, Carrazana E Epilepsia. 2020; 61(3):455-464.

PMID: 32065672 PMC: 7154760. DOI: 10.1111/epi.16449.

Determination of minimal steady-state plasma level of diazepam causing seizure threshold elevation in rats.

Dhir A, Rogawski M Epilepsia. 2018; 59(5):935-944.

PMID: 29682729 PMC: 5934328. DOI: 10.1111/epi.14069.

References

Ahmad S, Ellis J, Kamwendo H, Molyneux E . Efficacy and safety of intranasal lorazepam versus intramuscular paraldehyde for protracted convulsions in children: an open randomised trial. Lancet. 2006; 367(9522):1591-7. DOI: 10.1016/S0140-6736(06)68696-0. View

Riss J, Cloyd J, Gates J, Collins S . Benzodiazepines in epilepsy: pharmacology and pharmacokinetics. Acta Neurol Scand. 2008; 118(2):69-86. DOI: 10.1111/j.1600-0404.2008.01004.x. View

Inokuchi R, Sato H, Nakamura K, Aoki Y, Shinohara K, Gunshin M . Motivations and barriers to implementing electronic health records and ED information systems in Japan. Am J Emerg Med. 2014; 32(7):725-30. DOI: 10.1016/j.ajem.2014.03.035. View

Wermeling D . Intranasal delivery of antiepileptic medications for treatment of seizures. Neurotherapeutics. 2009; 6(2):352-8. PMC: 5084214. DOI: 10.1016/j.nurt.2009.01.002. View

Agarwal S, Kriel R, Brundage R, Ivaturi V, Cloyd J . A pilot study assessing the bioavailability and pharmacokinetics of diazepam after intranasal and intravenous administration in healthy volunteers. Epilepsy Res. 2013; 105(3):362-7. DOI: 10.1016/j.eplepsyres.2013.02.018. View

de Araujo Furtado M, Rossetti F, Chanda S, Yourick D . Exposure to nerve agents: from status epilepticus to neuroinflammation, brain damage, neurogenesis and epilepsy. Neurotoxicology. 2012; 33(6):1476-1490. DOI: 10.1016/j.neuro.2012.09.001. View

Ivaturi V, Riss J, Kriel R, Cloyd J . Pharmacokinetics and tolerability of intranasal diazepam and midazolam in healthy adult volunteers. Acta Neurol Scand. 2009; 120(5):353-7. DOI: 10.1111/j.1600-0404.2009.01170.x. View

Shorvon S . The historical evolution of, and the paradigms shifts in, the therapy of convulsive status epilepticus over the past 150 years. Epilepsia. 2013; 54 Suppl 6:64-7. DOI: 10.1111/epi.12281. View

Nair P, Kalita J, Misra U . Status epilepticus: why, what, and how. J Postgrad Med. 2011; 57(3):242-52. DOI: 10.4103/0022-3859.81807. View

10.

Inokuchi R, Sato H, Nakajima S, Shinohara K, Nakamura K, Gunshin M . Development of information systems and clinical decision support systems for emergency departments: a long road ahead for Japan. Emerg Med J. 2013; 30(11):914-7. DOI: 10.1136/emermed-2012-201869. View

11.

Scott R, Besag F, Neville B . Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet. 1999; 353(9153):623-6. DOI: 10.1016/S0140-6736(98)06425-3. View

12.

Humphries L, Eiland L . Treatment of acute seizures: is intranasal midazolam a viable option?. J Pediatr Pharmacol Ther. 2013; 18(2):79-87. PMC: 3668946. DOI: 10.5863/1551-6776-18.2.79. View

13.

Hirsch L, Donner E, So E, Jacobs M, Nashef L, Noebels J . Abbreviated report of the NIH/NINDS workshop on sudden unexpected death in epilepsy. Neurology. 2011; 76(22):1932-8. PMC: 3115809. DOI: 10.1212/WNL.0b013e31821de7de. View