Abstract
Benzodiazepines such as diazepam, lorazepam and midazolam remained the mainstay of treatment for acute repetitive seizures (ARS). The immediate care for ARS should often begin at home by a caregiver. This prevents the progression of ARS to prolonged seizures or status epilepticus. For a long time and despite social objections rectal diazepam gel remained only FDA-approved rescue medication. Intranasal administration of benzodiazepines is considered attractive and safe compared with rectal, buccal and sublingual routes. Intranasal delivery offers numerous advantages such as large absorptive surface area, bypass the first-pass metabolism and good patient acceptance as it is needle free and painless. Recent clinical studies have demonstrated that diazepam nasal spray (NRL-1; Valtoco®, Neurelis Inc.,San Diego, CA, USA) showed less pharmacokinetic variability and reliable bioavailability compared with the diazepam rectal gel. Diazepam nasal spray could be considered as a suitable alternative for treating seizure emergencies outside the hospital. This review summarizes the treatment options for ARS and findings from clinical studies involving intranasal diazepam for treating seizure emergencies.
Highlights
An epileptic seizure is a neurologic condition marked by the occurrence of sudden and unpredictable interruption of neurons in the brain [1]
The results showed that the bioavailability was 50.4 ± 23.3%, and the peak concentration was achieved after 18 ± 11 min following intranasal administration
This study reported reasonable bioavailability from intranasal diazepam with less tolerability as volunteers reported of discomfort after intranasal administration
Summary
An epileptic seizure is a neurologic condition marked by the occurrence of sudden and unpredictable interruption of neurons in the brain [1]. Epilepsy is characterized by two or more unprovoked seizures occurring 24 h apart. 80% of seizures are unpredictable and sporadic, while 20% of seizures have a cyclical recurrence at somewhat predictable time intervals of days or weeks. Acute repetitive seizures (ARS) or seizure clusters are often observed in patients with epilepsy. ARS is characterized by multiple seizures in less than 24 h for adults or in less than twelve hours for children. Children with recurrent seizures exhibit characteristic episodes of repetitive seizures distinctly different from their usual seizure behavior. The terms used to describe this phenomenon in the past include serial, cluster, recurrent, flurries, repetitive seizures, and crescendo seizures [1,5]
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