‘Autoinjector’ Offers Safe, Speedy Care for Life-Threatening Seizures: Study

WEDNESDAY, Feb. 15 (HealthDay News) — Using an autoinjector
device to deliver anti-seizure drugs into muscle is a fast, safe and
effective way to treat status epilepticus, a prolonged type of seizure
that lasts longer than five minutes, researchers report.

“This is a very important study for persons with epilepsy,” said one
outside expert, Dr. Jacqueline French, first vice president of the
American Epilepsy Society. “Prolonged seizures and status epilepticus can
lead to brain damage, prolonged hospitalization, and other serious harm.
The earlier treatment is initiated, the greater the likelihood that the
seizure activity can be aborted quickly, and harm can be avoided,” she
said.

French, who is also professor of neurology at the Comprehensive
Epilepsy Center at New York University Langone Medical Center, New York
City, believes the study “will set a new standard for treatment by
emergency teams, that will lead to substantial benefit for persons with
epilepsy.”

The study, funded by the U.S. National Institute of Neurological
Disorders and Stroke (NINDS), appears in the Feb. 16 issue of the New
England Journal of Medicine
.

Status epilepticus is a serious, potentially life-threatening medical
emergency that causes 55,000 deaths each year in the United States.
First-line treatment typically involves intravenous (IV) delivery of
anti-seizure drugs. However, starting an IV in a patient having a seizure
can be challenging for paramedics and takes up precious time.

This study, carried out by paramedics, examined whether using an
autoinjector to deliver an anti-seizure drug directly into a patient’s
thigh muscle is as safe and effective as using an IV. The researchers
compared how well each method stopped patients’ seizures by the time the
ambulance arrived at the emergency department.

Two different seizure-fighting medicines — midazolam and lorazepam —
were used in the study. Both are benzodiazepines and are known to be
effective in controlling seizures. Midazolam was used in the autoinjectors
because it is rapidly absorbed from muscle.

The researchers say that 73 percent of patients who received midazolam
through an autoinjector were seizure-free when they arrived at the
emergency department, compared with 63 percent of those who received IV
treatment with lorazepam.

Patients in the autoinjector/midazolam group were also less likely to
require hospitalization than those in the IV/lorazepam group. Both groups
had similarly low rates of recurrent seizures.

“Patients with status epilepticus can suffer severe consequences if
seizures are not stopped quickly. This study establishes that rapid
intramuscular injection of an anticonvulsant drug is safe and effective,”
Dr. Walter Koroshetz, NINDS deputy director, said in an institute news
release.

Another expert agreed.

“This study represents a major step toward keeping epilepsy patients
safer from the serious neurologic and medical risks of prolonged status
epilepticus,” said Dr. Cynthia Harden, chief of the Division of Epilepsy
and Electroencephalography at the Cushing Neuroscience Institute, part of
the North Shore-LIJ Health System in Manhasset, N.Y.

Could the autoinjector be safely used by non-medical personnel, such as
family or friends? Harden said only more research can tell. “The device
has great value in the clinical setting, when used by paramedics,” she
said, “and the safety of its use by non-medical persons such as family
members remains to be clarified.”

The study authors agreed. Currently, they said, the use of midazolam
requires on-site medical supervision, and further research is needed
before autoinjectors with the drug might be available for use by epilepsy
patients and their family members.

More information

The Epilepsy Foundation has more about status epilepticus.

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