[P4.250] Benzodiazepine Administration for Seizure Emergencies: A Review

Sheryl Haut,1Syndi Seinfeld,2John Pellock2
1New York, NY, USA, 2Richmond, VA, USA

Review literature describing benzodiazepine administration for treatment of seizure emergencies by routes other than those FDA approved.
Benzodiazepines are considered effective rescue therapies for seizure emergencies. Current FDA-approved routes of administration (intravenous and rectal) can be associated with administration challenges, and several alternative routes have been reported. Here we present a review of published data on safety, efficacy, and tolerability of benzodiazepines administered by various routes for treatment of seizure emergencies.
Systemic review of Scopus, using “English language,” “human subject,” and “article” filters. Search terms: Acute Seizures; Acute Repetitive Seizures; Prolonged Seizure; Seizure Clusters; Seizure Emergency; Seizure + Out of Hospital; Status Epilepticus + individual benzodiazepines (clobazam, clonazepam, diazepam, lorazepam, midazolam). Studies using benzodiazepines for maintenance therapy, as second-line treatment, or in combination with other antiepileptic drugs were excluded.
In total, 100 unique citations were identified. Of these, 61 were in children, 28 were in adults, and 11 in children and adults. Intranasal, buccal, and intramuscular benzodiazepines were faster to administer to pediatric subjects than IV and rectal. Time from benzodiazepine administration to termination of seizure activity was generally rapid with no significant difference between routes of administration (IV, 1.0-5.0 minutes (min); rectal, 1.3-15.0 min; buccal, 2.8-10.0 min; IM, .25-7.8 min; IN, 2.3-15.0 min). In some studies, caregivers found buccal and intranasal methods more acceptable than rectal administration. Respiratory adverse events (persistent O2 saturation <92% or <12 breaths/min) were more frequently found with IV administration versus other routes (IV: 0-20.6%; rectal, 0-6.0%; buccal/oral, 0-5.0%; IM, 0-12.0%; IN, 2.0% [reported only in one study]).
Emerging benzodiazepine administration methods appear to offer a rapid and convenient alternative to IV or rectal routes. The literature supports that these methods are safe and effective alternative routes of benzodiazepine administration for rapid treatment of seizures in children and adults.

Category - Epilepsy and Clinical Neurophysiology (EEG): Other

Wednesday, April 30, 2014 7:30 AM

P4: Poster Session IV: Epilepsy and Clinical Neurophysiology (7:30 AM-11:00 AM)


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