|
|
 | |||||||||||||||||||||||||||||||||||||||||||||||
 | |||||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||
Background Acute repetitive seizures are readily recognizable episodes involving increased seizure frequency. Urgent treatment is often required. Rectal diazepam gel is a promising therapy.
Methods We conducted a randomized, double-blind, parallel-group, placebo-controlled study of home-based treatment for acute repetitive seizures. Patients were randomly assigned to receive either rectal diazepam gel, at doses ranging from 0.2 to 0.5 mg per kilogram of body weight on the basis of age, or placebo. Children received one dose at the onset of acute repetitive seizures and a second dose four hours later. Adults received three doses — one dose at onset, and two more doses 4 and 12 hours after onset. Treatment was administered by a care giver, such as a parent, who had received special training. The number of seizures after the first dose was counted for 12 hours in children and for 24 hours in adults.
Results Of 125 study patients (64 assigned to diazepam and 61 to placebo) with a history of acute repetitive seizures, 91 (47 children and 44 adults) were treated for an exacerbation of seizures during the study period. Diazepam treatment was superior to placebo with regard to the outcome variables related to efficacy: reduced seizure frequency (P<0.001) and improved global assessment of treatment outcome by the care giver (frequency and severity of seizures and drug toxicity) (P<0.001). Post hoc analysis showed diazepam to be superior to placebo in reducing seizure frequency in both children (P<0.001) and adults (P=0.02), but only in children was it superior with regard to improvement in global outcome (P<0.001). The time to the first recurrence of seizures after initial treatment was longer for the patients receiving diazepam (P<0.001). Thirty-five patients reported at least one adverse effect of treatment; somnolence was the most frequent. Respiratory depression was not reported.
Conclusions Rectal diazepam gel, administered at home by trained care givers, is an effective and well-tolerated treatment for acute repetitive seizures.
Source Information
From the Department of Neurology, University of Virginia, Charlottesville (F.E.D.); the Division of Pediatric Neurology, New England Medical Center, Boston (N.P.R.); the College of Pharmacy, University of Minnesota, Minneapolis (J.C.C.); the Department of Neurology, Medical College of Virginia, Richmond (J.M.P.); the Department of Neurology, University of Alabama at Birmingham, Birmingham (R.I.K.); the Department of Pediatrics, Children's Hospital, Columbus, Ohio (W.D.L.); the Department of Neurology, University of Utah, Salt Lake City (F.M.); the Department of Neurology, Arkansas Children's Hospital, Little Rock (G.B.S.); the Department of Neurology, Children's National Medical Center, Washington, D.C. (J.A.C.); the Department of Neurological Sciences, Rush–Presbyterian–St. Luke's Medical Center, Chicago (D.C.B.); and the National Institutes of Health, Bethesda, Md. (W.E.B.).
Address reprint requests to Dr. Rosman at the Division of Pediatric Neurology, NEMC 330, Floating Hospital for Children, 750 Washington St., Boston, MA 02111.
Related Letters:
Treatment of Acute Repetitive Seizures
Orr R. D., Shafrir Y., Rosman N. P., Cloyd J. C., Bell W. E.
Extract |
Full Text
N Engl J Med 1998;
339:1856-1857, Dec 17, 1998.
Correspondence
This article has been cited by other articles:
HOME | SUBSCRIBE | SEARCH | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | PRIVACY | HELP | beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved. |
Previous
