Intranasal midazolam

Lara Kay, Philipp S. Reif,  Marcus Belke, Sebastian Bauer, Detlef Fründ, Susanne Knake, Felix Rosenow, Adam Strzelczyk.  Intranasal midazolam during presurgical epilepsy monitoring is well tolerated, delays seizure recurrence, and protects from generalized tonic–clonic seizures.  Epilepsia.  published online: 27 JUL 2015.

Summary

Objective

To evaluate the tolerability and efficacy of the ictal and immediate postictal application of intranasal midazolam (in-MDZ) in adolescents and adults during video–electroencephalography (EEG) monitoring.

Methods

Medical records of all patients treated with in-MDZ between 2008 and 2014 were reviewed retrospectively. For each single patient, the time span until recurrence of seizures was analyzed after an index seizure with and without in-MDZ application. To prevent potential bias, we defined the first seizure with application of in-MDZ as the in-MDZ index seizure. The control index seizure was the preceding, alternatively the next successive seizure without application of in-MDZ.

Results

In total, 75 epilepsy patients (mean age 34 ± 14.7 years; 42 male, 33 female) were treated with in-MDZ (mean dose 5.1 mg). Adverse events were observed in four patients (5.3%), and no serious adverse events occurred. The median time after EEG seizure onset before administration of in-MDZ was 2.17 min (interquartile range [IQR] 03.82; range 0.13–15.0 min). Over the next 12 h after in-MDZ, the number of seizures was significantly lower (p = 0.031). The median seizure-free interval was significantly longer following treatment with in-MDZ (5.83 h; IQR 6.83, range 0.4–23.87) than it was for those with no in-MDZ treatment (2.37 h; IQR 4.87, range 0.03–21.87; p = 0.015). Conversely, the likelihood of the patient developing a subsequent seizure was four times higher (odds ratio [OR] 4.33, 95% confidence interval [CI] 1.30–14.47) in the first hour and decreased gradually after 12 h (OR 1.5, 95% CI 1.06–2.12). The occurrence of generalized tonic–clonic seizures was lower in the in-MDZ group in the 24-h observation period (OR 4.67, 95% CI 1.41–15.45; p = 0.009).

Significance

Ictal and immediate postictal administration of in-MDZ was well tolerated and not associated with serious adverse events. We demonstrated a significant reduction of subsequent seizures (all seizure types) for a 12 h period and of generalized tonic–clonic seizures for 24 h following in-MDZ.

Courtesy of:  http://www.medpagetoday.com/Neurology/Seizures/52830?xid=nl_mpt_DHE_2015-07-30&eun=g906366d0r