Autoinjectors offer way to treat prolonged seizures
An NIH study has found a safe and effective way for paramedics to treat prolonged seizures.
Balintfy: Seizures are symptoms of a brain problem. They happen because of sudden, abnormal electrical activity in the brain. Most seizures last from 30 seconds to 2 minutes and do not cause lasting harm. But some seizures can last longer than 5 minutes or a person may have many seizures and not wake up between them.
Koroshetz: Status epilepticus is basically seizures that are just not stopping.
Balintfy: Dr. Walter Koroshetz is deputy director at the NIH institute researching the brain and nervous system.
Koroshetz: It's an extremely dangerous condition. Unfortunately, some people will go on and may seize for months at a time and the best chance of stopping it is right at the beginning.
Balintfy: Status epilepticus is a potentially life-threatening emergency that causes 55,000 deaths each year. Standard treatment has been anticonvulsant drugs, including lorazepam, which are typically given intravenously, through an IV.
Koroshetz: Now, you can imagine if you've seen somebody who is seizing that they are moving sometimes violently and it's really hard to start an IV.
Balintfy: Dr. Koroshetz explains that a new study is looking at using the drug midazolam as a first line treatment.
Koroshetz: It's been known for a long time that midazolam is effective at controlling seizures. It's easier to give. So people in the emergency setting have been using midazolam intramuscularly.
Balintfy: Midazolam is given directly into a muscle with an autoinjector, much like the EpiPen used to treat serious allergic reactions.
Koroshetz: The problem was there was no evidence before to indicate that the dose was right, that it was equivalent to what had previously been defined as the standard of care, which was the lorazepam dose.
Balintfy: Dr. Koroshetz says this new study, which is a pragmatic comparative effectiveness trial, compared the midazolam treatment with the standard of care.
Koroshetz: This study shows that using an autoinjector that just injects right into the muscle is as effective as the previous standard which was starting the IV and giving the meds.
Balintfy: The investigators add that more research is required to see if autoinjectors might someday be available for use by patients with epilepsy, a brain disorder that causes people to have recurring seizures. Midazolam has a strong sedative effect which requires on-site medical supervision of patients. Dr. Koroshetz also points out that another purpose of this study was to find ways to stop seizures in the event of a chemical accident or attack by nerve agents, many of which cause seizures.
Koroshetz: Should there ever be an emergency where hundreds of people are exposed to a nerve agent that causes seizures, the people who respond to take care of those affected individuals are never going to be able to start a hundred IV lines in the timeframe necessary, but they could come in with hundreds of these autoinjectors and just go around and just inject into the muscle of people who are seizing.
Balintfy: He adds that this treatment could be put into a stockpile of countermeasures that the government holds in case of chemical accident or attack. Partners in the study include the NIH Countermeasures Against Chemical Threats, the Biomedical Advanced Research and Development Authority and the Department of Defense.
Koroshetz: But also, it's a huge effort that was taken part around the country by almost 4,000 emergency responders who go out on ambulances and respond to people who have seizures.
Balintfy: The trial involved an NIH-run network of emergency physicians in 79 different hospitals working with ambulance crews that treated 893 patents. Findings are published in the New England Journal of Medicine. For more information on the study, visit www.ninds.nih.gov. For NIH Radio, this is Joe Balintfy— NIH...Turning Discovery Into Health®
About This Audio Report
Reporter: Joe Balintfy
Sound Bite: Dr. Walter Koroshetz
Topic: autoinjectors, seizure, seizures, prolonged seizures, status epilepticus, brain,
Additional Info: Autoinjectors offer way to treat prolonged seizures