Combination Drug Therapy in Refractory Epilepsy

J Gordon Millichap
2012 Pediatric Neurology Briefs  
Pediatric Neurology Briefs 2012 18 COMMENT. In an editorial, Hirsch LJ of Yale University Epilepsy Center notes that the mortality of status epilepticus is 15 to 22% and the outcome correlates with seizure duration. (N Engl J Med 2012;366:659-660). The definition of status has been shortened from 30 minutes to 5 to 10 minutes in recent studies. Seizures lasting > 5 minutes are likely to be self-sustained and require intervention. The RAMPAR Trial reported above found that the more rapid
more » ... more rapid administration of the IM midazolam (1.2 min) than the IV lorazepam (4.8 min) outweighed the faster cessation of seizures with intravenous administration (1.6 min IV vs 3.3 min via IM route). The rate of hospitalization was lower in the IM-midazolam group, as compared with the IVlorazepam group (57.6% vs 65.6%). Dr Hirsch comments that home treatment for status epilepticus may be found more satisfactory in the future, using the nasal or buccal routes for administering midazolam.
doi:10.15844/pedneurbriefs-26-3-2 fatcat:kflf5cdr6ngppdwutyhunsegw4