Intranasal Midazolam Rapidly Effective, Safe Alternative to Intravenous Therapy in Status Epilepticus

Lara Kay, MD

Intranasal midazolam is both safe and rapidly effective as an alternative first-line therapy for status epilepticus, according to findings presented at the 2019 International Epilepsy Congress June 22-26, in Bangkok, Thailand.¹

Status epilepticus is typically treated with intravenous or intramuscular benzodiazepines, including lorazepam, diazepam, and midazolam. Phenytoin and phenobarbital are also widely used despite a questionable safety profile.²

The current study, led by Lara Kay, MD, of Goethe University in Frankfurt, Germany, sought to evaluate the efficacy and tolerability of intranasal midazolam in hospitalized patients with status epilepticus who underwent continuous EEG.

The retrospective study included medical records of patients treated between August 2015 and April 2018, and included data on medical history, etiology and semiology of status epilepticus, and antiepileptic therapy.

Analysis included time to end of status epilepticus in relation to administration of intranasal midazolam, as well as beta-band effects, which were evaluated by 2, independent, board-certified epileptologists.

Overall, the study included 42 patients (23 female; mean age, 52.7) who were treated with a median dose of 5 mg intranasal midazolam (range, 2.5-15 mg, mean 6.4 mg [SD 2.6]). Most patients (55.8%) presented with non-convulsive status epilepticus.

Among the cohort, 57.1% were considered responders, with status epilepticus stopping following the administration of intranasal midazolam and no other drugs. On EEG, status epilepticus ceased on average 5:05 minutes following administration of the therapy (median, 4:56 minutes; range 29 seconds-14:53 minutes, SD 3:13 minutes).

An increased beta-band was observed on EEG on average 4:07 minutes following therapy administration (median, 3:50 minutes; range 2:20 minutes-5:40 minutes, SD 1:09 minutes). Adverse events included nasal irritation (n=5; 11.9%) and prolonged sedation (n=1, 2.6%).

Based on their findings, “intranasal administration of midazolam appears to be an easily applicable and rapidly effective alternative to buccal and intramuscular application as first line treatment if an intravenous route is not available,” Kay and colleagues concluded.

For more coverage of IEC 2019, click here.

REFERENCES

1. Kay L, Merkel N, von Blomberg A, et al. Intranasal midazolam as initial in-hospital treatment for status epilepticus: a pharmaco-EEG cohort study. Presented at: 2019 International Epilepsy Congress. June 22-26, 2019; Bangkok, Thailand. P029.

2. Trinka E, Höfler J, Leitinger M, Brigo F. Pharmacotherapy for status epilepticus. Drugs. 2015;75(13):1499-1521.