Know new pharmacological approaches for seizure
There are several new management approaches for seizure, including IM midazolam, propofil, and rectal medications, which nurses should be aware of, says Alfred Sacchetti, MD, FACEP, an emergency physician at Our Lady of Lourdes Medical Center in Camden, NJ.
· IM Midazolam. Studies have shown that midazolam can effectively treat children with status epilepticus.1 "Another study found that IM midazolam was found to be an effective alternative to IV diazepam in these children with motor seizures," says Sacchetti.2
Some children with continuous seizures may fail to respond to standard treatment with IV diazepam and phenytoin, notes Sacchetti. "Midazolam is a water-soluble benzodiazepine that rapidly diffuses into the central nervous system when given by the intravenous route, and has a short elimination half life (1.5-3.5 hours). It is an effective preanesthetic agent, and has been noted in animal studies and anecdotal reports in humans to have pronounced anticonvulsant effects," he says.
· Propofil. "This is used the same as pentobarbital or amylbarbital, to induce coma,"3,4 says Sacchetti. "The standard load of 0.5-1.5 mg/kg is used, then a continuous drip to maintain sedation. It should be noted that some believe propofil may worsen seizures, but I've never seen any evidence to that effect."
· Rectal medications. Rectal administration of anti-epileptic drugs can be beneficial for seizure management, especially when the need for treatment is urgent. Advantages of rectal administration include easy access, reliable, consistent absorption for lipid-soluble drugs, and rapid systemic effects.5 One study reported that after treatment with rectal diazepam, 81% of children in status epilepticus stopped seizuring, and after treatment with IV diazepam, 100% stopped seizuring.6
References
1. Koul RL, et al. Continuous midazolam infusion as treatment of status epilepticus. Arch Dis Child 1997;76:445.
2. Chamberlain JM, et al. A prospective randomized study comparing intramuscular midzolam with intravenous diazepam for the treatment of seizures in children. Pediatr Emerg Care 1997;13:92-94.
3. Mitchell WG. Status epilepticus and acute repetitive seizures in children, adolescents, and young adults: Etiology, outcome, and treatment. Epilepsia 1996; 37(sup 1):S74-80.
4. Kuisma M, Roine RO. Propofol in prehospital treatment of convulsive status epilepticus. Epilepsia 1995;36(12):1241-1243.
5. Rectal administration of antiepileptic drugs and its role in the management of seizure emergencies. A CME/CPE Monograph sponsored by the University of Minnesota Medical School and College of Pharmacy. Author: James Cloyd, PharmD. 1998: Medicalliance, Inc.
6. Deickmann RA. Rectal diazepam for prehospital pediatric status epilepticus. Ann Emerg Med. 1994; 23:216-224.
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