Yale New Haven Health, Department of Pharmacy, 20 York Street, New Haven, CT 6510, United States of America; Yale New Haven Health, Office of Strategy Management, 200 Orchard Street, New Haven, CT 06511, United States of America.
Division of Epilepsy, Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, United States of America; Department of Neurology, Yale School of Medicine, New Haven, CT 06510, United States of America.
Epilepsy Behav. 2019 Sep;98(Pt A):161-167. doi: 10.1016/j.yebeh.2019.07.021. Epub 2019 Jul 30.
The objective of the study was to compare the performance of intravenous (IV) lorazepam (IVL) and intranasal midazolam (INM) for seizure termination and prevention of seizure clusters in adults admitted to the epilepsy monitoring unit (EMU) in whom seizures were captured on continuous video-electroencephalogram.
Retrospective cohort of consecutive adults (≥18 years) with epilepsy admitted to the EMU at a single tertiary academic center, who experienced epileptic seizures (confirmed electroencephalographically) and required rescue therapy. The study spanned from January 2015 until December 2016, which included one year before and one year after transitioning from IVL to INM as the standard rescue therapy at our institution.
A total of 50 subjects received rescue therapy and were included in the analysis. In the first year, out of 216 patients with epilepsy admitted to the EMU, 27 (13%) received IVL; in the second year, 23/217 (11%) received INM. There were no differences in baseline characteristics and markers of epilepsy severity, the median duration of index seizure (1.7 min [interquartile range (IQR): 1.1-2.7] in IVL vs. 2.0 min [IQR: 1.5-2.6] in INM group, p = 0.20), or in the number of subjects requiring repeat benzodiazepine administrations (IVL 8/27 [29.6%] vs. INM 7/23 [30.4%], p = 0.95). There were no differences in the median number of recurrent seizures in 24 h (1 [IQR: 1-3] in IVL vs. 2 [IQR: 1-4] in INM, p = 0.27), occurrence of status epilepticus (IVL 4/27 [14.8%] subjects vs. INM 1/23 [4.3%] subjects, p = 0.36), incidence of seizure clusters (IVL 8/27 [29.6%] subjects vs. INM 7/23 [30.4%] subjects, p = 0.95), need for transfer to an intensive care unit (ICU), or other adverse events.
In our retrospective study, INM was comparable with IVL for seizure termination and prevention of seizure clusters in the adult EMU. Intranasal midazolam circumvents the need for IV access to be maintained throughout hospitalization and is an attractive alternative to IVL as a rescue therapy in this setting. Ideally, future large, prospective, randomized, and double blind studies are needed to confirm these findings.
本研究旨在比较静脉内（IV）劳拉西泮（IVL）和鼻内咪达唑仑（INM）在因癫痫发作而入院的癫痫监测单元（EMU）中的成人中终止癫痫发作和预防癫痫发作的疗效，这些患者的癫痫发作在连续视频脑电图上被捕获。
这是一项在单一的三级学术中心进行的连续成年（≥18 岁）癫痫患者回顾性队列研究，这些患者经历了癫痫发作（经脑电图证实）并需要抢救治疗。研究时间跨度为 2015 年 1 月至 2016 年 12 月，包括在我们机构将 IVL 转换为 INM 作为标准抢救治疗之前和之后的一年。
共有 50 名接受抢救治疗的受试者被纳入分析。在第一年，在 216 名被收入 EMU 的癫痫患者中，有 27 名（13%）接受了 IVL；第二年，有 23 名（11%）接受了 INM。两组患者的基线特征和癫痫严重程度标志物、指数发作的中位数持续时间（IVL 组为 1.7 分钟[四分位距（IQR）：1.1-2.7]，INM 组为 2.0 分钟[IQR：1.5-2.6]，p=0.20）或需要重复苯二氮䓬类药物治疗的患者数量（IVL 组为 8/27[29.6%]，INM 组为 7/23[30.4%]，p=0.95）均无差异。24 小时内复发癫痫发作的中位数数量（IVL 组为 1[IQR：1-3]，INM 组为 2[IQR：1-4]，p=0.27）、癫痫持续状态的发生率（IVL 组为 4/27[14.8%]患者，INM 组为 1/23[4.3%]患者，p=0.36）、癫痫发作簇的发生率（IVL 组为 8/27[29.6%]患者，INM 组为 7/23[30.4%]患者，p=0.95）、需要转入重症监护病房（ICU）或其他不良事件均无差异。
在我们的回顾性研究中，INM 在终止癫痫发作和预防成年 EMU 中的癫痫发作簇方面与 IVL 相当。鼻内咪达唑仑避免了在整个住院期间维持静脉通路的需要，并且是 IVL 的一种有吸引力的替代方法，作为该环境中的抢救治疗。理想情况下，需要未来进行大型、前瞻性、随机、双盲研究来证实这些发现。
