Intranasal Midazolam Reduces Seizure Frequency

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Intranasal midazolam (in-MDZ) may be an effective and tolerable treatment for seizure, according to results from a study published in Epilepsia.

Lara Kay, of Philipps-University in Marburg, Germany, and colleagues reviewed the medical records of 75 epilepsy patients (mean age 34 ± 14.7 years; 42 male, 33 female) treated with in-MDZ between 2008 and 2014. Time to recurring seizure was analyzed in all patients.

Prior to administration of in-MDZ, the median time after video-electroencephalography (EEG) seizure onset was 2.17 minutes. In the 12 hours after administration of in-MDZ, the number of seizures dropped significantly (P=0.031), and the median seizure-free interval was significantly longer (5.83 h; IQR 6.83, range 0.4–23.87) following treatment than it was for patients not taking in-MDZ (2.37 h; IQR 4.87, range 0.03–21.87; p = 0.015). Those treated with in-MDZ also had lower occurrence of generalizes tonic-clonic seizures during the 24-hour observation period (OR 4.67, 95% CI 1.41–15.45; p = 0.009). However, the risk of subsequent seizure was four times higher (odds ratio [OR] 4.33, 95% confidence interval [CI] 1.30–14.47) in the first hour and decreased gradually after 12 hours (OR 1.5, 95% CI 1.06–2.12).

Four patients (5.3%) had adverse events, but no serious adverse events were reported. Therefore, inctal and immediate postictal administration of in-MDZ seemed well-tolerated with little risk of serious adverse event.

Intranasal Midazolam Reduces Seizure Frequency

Lara Kay, of Philipps-University in Marburg, Germany, and colleagues evaluated the tolerability and efficacy of the ictal and immediate postictal application of intranasal midazolam (in-MDZ) in adolescents and adults during video–electroencephalography (EEG) monitoring.

Medical records of all patients treated with in-MDZ between 2008 and 2014 were reviewed retrospectively. For each single patient, the time span until recurrence of seizures was analyzed after an index seizure with and without in-MDZ application. To prevent potential bias, we defined the first seizure with application of in-MDZ as the in-MDZ index seizure. The control index seizure was the preceding, alternatively the next successive seizure without application of in-MDZ.

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