Jeannette Kadel1, Sebastian Bauer1,2, Anke M Hermsen1, Ilka Immisch2, Lara Kay1, Karl Martin Klein1,2, Susanne Knake2, Katja Menzler2, Philipp S Reif1, Felix Rosenow1,2, Adam Strzelczyk3,4. 1. Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16, Haus 95, 60528, Frankfurt am Main, Germany. 2. Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany. 3. Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16, Haus 95, 60528, Frankfurt am Main, Germany. strzelczyk@med.uni-frankfurt.de. 4. Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany. strzelczyk@med.uni-frankfurt.de.
Abstract
BACKGROUND: Emergency treatment with benzodiazepines is indicated in prolonged seizures, seizure clusters and status epilepticus. OBJECTIVE: The aim of this study was to evaluate the use of emergency medication in adult patients with epilepsy. PATIENTS AND METHODS: All adult epilepsy patients attending the epilepsy outpatient clinics of the university hospitals in Frankfurt and Marburg in 2015 were asked to participate in this questionnaire-based, retrospective survey. RESULTS: A total of 481 patients with a mean age of 43.4 years (range 18-94 years, 54% female) participated in the study. Among them, 134 patients (27.9%) reported on the prescription of an emergency medication during the last year. Patients receiving emergency medication were younger and exhibited a lower age at epilepsy onset, a higher seizure frequency and a higher number of regularly taken antiepileptic drugs. The most frequently taken emergency drugs were oral lorazepam tablets (65.7%; n = 88 out of 134), followed by buccal midazolam (23.9%, n = 32) and rectal diazepam (17.9%, n = 24). The most common indications for administering the emergency medication were seizures continuing for several minutes (35.1%, n = 47), but almost the same number of patients (33.6%, n = 45) stated that the rescue medication was given during or after every seizure. Regarding adverse events, sedation was named as a major (18.7%, n = 25) or moderate (29.1%; n = 39) problem by a substantial number of patients. Difficulties in administration were reported by 17 (13%) patients. Two-thirds assessed the efficacy of their emergency medication as good (50.7%, n = 68) or as very good (15.7%, n = 21). For multivariate logistic regression analysis, aspects such as young age at onset, active epilepsy, structural etiology, presence of generalised tonic-clonic seizures, past medical history of status epilepticus and living with another person independently predicted prescription of emergency medication. CONCLUSIONS: In most cases, unsuitable benzodiazepines with slow absorption due to oral administration were prescribed, or buccal midazolam solution was used off-label in adults. Furthermore, inappropriate use of emergency medication at every seizure was reported by a substantial number of participating patients.
BACKGROUND: Emergency treatment with benzodiazepines is indicated in prolonged seizures, seizure clusters and status epilepticus. OBJECTIVE: The aim of this study was to evaluate the use of emergency medication in adult patients with epilepsy. PATIENTS AND METHODS: All adult epilepsypatients attending the epilepsyoutpatient clinics of the university hospitals in Frankfurt and Marburg in 2015 were asked to participate in this questionnaire-based, retrospective survey. RESULTS: A total of 481 patients with a mean age of 43.4 years (range 18-94 years, 54% female) participated in the study. Among them, 134 patients (27.9%) reported on the prescription of an emergency medication during the last year. Patients receiving emergency medication were younger and exhibited a lower age at epilepsy onset, a higher seizure frequency and a higher number of regularly taken antiepileptic drugs. The most frequently taken emergency drugs were oral lorazepam tablets (65.7%; n = 88 out of 134), followed by buccal midazolam (23.9%, n = 32) and rectal diazepam (17.9%, n = 24). The most common indications for administering the emergency medication were seizures continuing for several minutes (35.1%, n = 47), but almost the same number of patients (33.6%, n = 45) stated that the rescue medication was given during or after every seizure. Regarding adverse events, sedation was named as a major (18.7%, n = 25) or moderate (29.1%; n = 39) problem by a substantial number of patients. Difficulties in administration were reported by 17 (13%) patients. Two-thirds assessed the efficacy of their emergency medication as good (50.7%, n = 68) or as very good (15.7%, n = 21). For multivariate logistic regression analysis, aspects such as young age at onset, active epilepsy, structural etiology, presence of generalised tonic-clonic seizures, past medical history of status epilepticus and living with another person independently predicted prescription of emergency medication. CONCLUSIONS: In most cases, unsuitable benzodiazepines with slow absorption due to oral administration were prescribed, or buccal midazolam solution was used off-label in adults. Furthermore, inappropriate use of emergency medication at every seizure was reported by a substantial number of participating patients.
Authors: Maija Holsti; Nanette Dudley; Jeff Schunk; Kathleen Adelgais; Richard Greenberg; Cody Olsen; Aaron Healy; Sean Firth; Francis Filloux Journal: Arch Pediatr Adolesc Med Date: 2010-08
Authors: D M Treiman; P D Meyers; N Y Walton; J F Collins; C Colling; A J Rowan; A Handforth; E Faught; V P Calabrese; B M Uthman; R E Ramsay; M B Mamdani Journal: N Engl J Med Date: 1998-09-17 Impact factor: 91.245
Authors: B K Alldredge; A M Gelb; S M Isaacs; M D Corry; F Allen; S Ulrich; M D Gottwald; N O'Neil; J M Neuhaus; M R Segal; D H Lowenstein Journal: N Engl J Med Date: 2001-08-30 Impact factor: 91.245
Authors: Gerrit-Jan de Haan; Peter van der Geest; Gerard Doelman; Edward Bertram; Peter Edelbroek Journal: Epilepsia Date: 2009-10-08 Impact factor: 5.864
Authors: Lara Kay; Philipp S Reif; Marcus Belke; Sebastian Bauer; Detlef Fründ; Susanne Knake; Felix Rosenow; Adam Strzelczyk Journal: Epilepsia Date: 2015-07-27 Impact factor: 5.864
Authors: Lara Kay; Nina Merkel; Anemone von Blomberg; Laurent M Willems; Sebastian Bauer; Philipp S Reif; Susanne Schubert-Bast; Felix Rosenow; Adam Strzelczyk Journal: Ann Clin Transl Neurol Date: 2019-11-04 Impact factor: 4.511
Authors: Adam Strzelczyk; Laurent M Willems; Ricardo Kienitz; Lara Kay; Isabelle Beuchat; Sarah Gelhard; Sophie von Brauchitsch; Catrin Mann; Alexandra Lucaciu; Jan-Hendrik Schäfer; Kai Siebenbrodt; Johann-Philipp Zöllner; Susanne Schubert-Bast; Felix Rosenow Journal: CNS Drugs Date: 2022-08-16 Impact factor: 6.497
Authors: Anemone von Blomberg; Lara Kay; Susanne Knake; Sven Fuest; Johann Philipp Zöllner; Philipp S Reif; Eva Herrmann; Ümniye Balaban; Susanne Schubert-Bast; Felix Rosenow; Adam Strzelczyk Journal: CNS Drugs Date: 2020-05 Impact factor: 5.749