If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  DG DISPATCH - AAN: Diazepam rectal gel effective for epilepsy By Richard Robinson Special to DG News
SAN DIEGO, CA -- May 1, 2000 -- Diazepam rectal gel provides prompt and effective treatment of status epilepticus for patients in long-term care facilities, research shows. Standard treatment for status epilepticus is intravenous lorazepam. Gaining intravenous access, however, is rarely easy in this population, due to lack of cooperation, muscular contractures, obesity and atrophy, explained Brian J. Fitzgerald, MD, of Fircrest Long-term Care Facility, in Seattle, WA. Dr. Fitzgerald presented his findings at the 52 Annual Meeting of the American Academy of Neurology, in San Diego, CA. Treatment delays may lead to increased seizure duration and neuronal injury. Therefore, Dr. Fitzgerald and colleagues tested the efficacy of diazepam gel (Diastat) as an alternative to IV lorazepam, in a study titled, "Treatment of out-of-hospital status epilepticus with diazepam rectal gel." In the study, patients were treated if they had 10 minutes or more of continuous generalized tonic-clonic seizure activity. From May 1996 to April 1998, they received 4 mg IV lorazepam; from May 1998 (when Diastat received approval) to April 1999, these same patients received 15-20 mg diazepam rectal gel. There were a total of 107 treatment attempts. All 36 of the diazepam treatment attempts were successful; 21 of the 71 lorazepam attempts were successful. "This is an indication of how easy it is to give the rectal gel," Dr. Fitzgerald explained. In addition, the gel can be administered by LPNs, rather than waiting for a registered nurse to place the IV line. Diazepam treatment was administered significantly faster (mean of 12 minutes vs. 20 minutes), although its time to seizure relief was longer (seven minutes vs. four minutes). Four of the 36 diazepam attempts resulted in seizures that lasted longer than 30 minutes; 20 of the 71 lorazepam attempts led to seizures of this duration. Total seizure time was significantly reduced for diazepam (18 minutes vs. 25 minutes, p<0.05). "Diazepam rectal gel was administered more quickly and more reliably," Dr. Fitzgerald said, and is more effective and safer than IV lorazepam in this patient population. Dr. Fitzgerald also noted that his institution has begun a new protocol, calling for intervention after five minutes, and that the number of 911 calls required for uncontrolled status epilepticus has fallen dramatically since they began using the rectal gel.
Related Links: diazepam gel (Diastat) and lorazepam.
|
