Charalambous M, Bhatti S F M, Van Ham L, Platt S, Jeffery N D, Tipold A, Siedenburg J, Volk H A, Hasegawa D, Gallucci A, Gandini G, Musteata M, Ives E, Vanhaesebrouck A E
Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
J Vet Intern Med. 2017 Jul;31(4):1149-1158. doi: 10.1111/jvim.14734. Epub 2017 May 24.
Intranasal administration of benzodiazepines has shown superiority over rectal administration for terminating emergency epileptic seizures in human trials. No such clinical trials have been performed in dogs.
To evaluate the clinical efficacy of intranasal midazolam (IN-MDZ), via a mucosal atomization device, as a first-line management option for canine status epilepticus and compare it to rectal administration of diazepam (R-DZP) for controlling status epilepticus before intravenous access is available.
Client-owned dogs with idiopathic or structural epilepsy manifesting status epilepticus within a hospital environment were used. Dogs were randomly allocated to treatment with IN-MDZ (n = 20) or R-DZP (n = 15).
Randomized parallel-group clinical trial. Seizure cessation time and adverse effects were recorded. For each dog, treatment was considered successful if the seizure ceased within 5 minutes and did not recur within 10 minutes after administration. The 95% confidence interval was used to detect the true population of dogs that were successfully treated. The Fisher's 2-tailed exact test was used to compare the 2 groups, and the results were considered statistically significant if P < .05.
IN-MDZ and R-DZP terminated status epilepticus in 70% (14/20) and 20% (3/15) of cases, respectively (P = .0059). All dogs showed sedation and ataxia.
IN-MDZ is a quick, safe and effective first-line medication for controlling status epilepticus in dogs and appears superior to R-DZP. IN-MDZ might be a valuable treatment option when intravenous access is not available and for treatment of status epilepticus in dogs at home.
在人体试验中，鼻内给予苯二氮䓬类药物在终止紧急癫痫发作方面已显示出优于直肠给药。尚未在犬类中进行此类临床试验。
评估通过黏膜雾化装置鼻内给予咪达唑仑（IN-MDZ）作为犬癫痫持续状态一线治疗方案的临床疗效，并将其与直肠给予地西泮（R-DZP）在建立静脉通路前控制癫痫持续状态的效果进行比较。
使用在医院环境中表现出癫痫持续状态的特发性或结构性癫痫的客户拥有的犬只。犬只被随机分配接受IN-MDZ治疗（n = 20）或R-DZP治疗（n = 15）。
随机平行组临床试验。记录癫痫发作停止时间和不良反应。对于每只犬，如果癫痫发作在给药后5分钟内停止且在10分钟内未复发，则认为治疗成功。使用95%置信区间来检测成功治疗的犬只的真实总体。采用Fisher双侧精确检验比较两组，若P <.05，则结果被认为具有统计学意义。
IN-MDZ和R-DZP分别在70%（14/20）和20%（3/15）的病例中终止了癫痫持续状态（P = 0.0059）。所有犬只均出现镇静和共济失调。
IN-MDZ是控制犬癫痫持续状态的快速、安全且有效的一线药物，似乎优于R-DZP。当无法建立静脉通路时以及在家中治疗犬癫痫持续状态时，IN-MDZ可能是一种有价值的治疗选择。
