Nav: Home

After a clinical trial on Midazolam for seizures, emergency use of the drug rises

March 23, 2017

ANN ARBOR, Mich. - For status epilepticus patients who experience seizures outside of the hospital, treatment administered on an ambulance is an important component of their overall care.

And, according to a new study, this care is improving thanks in part to increased knowledge around -- and availability of -- midazolam, a benzodiazepine.

"When people experience seizures we frequently call an ambulance, and they're treated with a benzodiazepine if they're still having a seizure when the ambulance arrives," says William Meurer, M.D., associate professor of emergency medicine at Michigan Medicine and a member of the Michigan Center for Integrative Research in Critical Care and the University of Michigan Institute for Healthcare Policy and Innovation. "There are a few type of benzodiazepines that can be used, one of which is midazolam."

Meurer is the senior author on a new study that investigated if previous research on midazolam's efficacy as a seizure treatment affected whether ambulances nationwide were choosing the drug over other benzodiazepines for seizure patients.

The team focused on a clinical trial, titled RAMPART and published in 2012, in which lead author Robert Silbergleit, M.D., also of Michigan Medicine, and his team demonstrated that midazolam was more effective in treating seizures than other benzodiazepines. Because it is injected, rather than administered through an IV, it is also faster to use, RAMPART found.

"Here, we have a situation where this drug works as a treatment, is faster to administer, is cheaper than others, and it's easier to use because it doesn't have to be refrigerated like some other benzos," Meurer says. "But, we know that the process of clinical trial findings moving into accepted clinical practice can take years and years. We wanted to see, after RAMPART was published, how quickly and how much did a clinical trial change what ambulances were doing across the country."

Meurer adds, "Ambulances are different than a doctor; for example, sometimes they make yearly decisions on what medicines they stock. If a doctor wants to start prescribing a different medication to a seizure patient, they can generally do so right away. With ambulances, there could be administrative delays from the agency."

Analyzing data

The research team used data from the National Emergency Medical Services Information System, a national repository of standardized patient care reports from EMS agencies across the country. They compared data from the two years prior to RAMPART's publication with the two years after its publication, when midazolam was used as the first-line treatment.

The team identified all patient care events, both pediatric and adult, where the patient was treated with benzodiazepines for seizures and presumed convulsive status epilepticus in the pre-hospital setting from Jan. 1, 2010, to Dec. 31, 2014.

They found 156,539 benzodiazepine-treated seizures. Using statistical analysis, the researchers concluded midazolam use increased from 26.1 percent in January 2010 to 61.7 percent in December 2014. In addition, the annual rate of EMS agencies adopting midazolam annually increased from 5.9 percent per year to 8.9 percent per year after the publication of RAMPART.

After adjusting for secular trends, demographic characteristics, EMS encounter characteristics and agency size, the team found the odds of a patient receiving midazolam were 24 percent higher after the RAMPART study's publication.

"We found a substantial increase in the use of midazolam and the rate at which it was adopted after RAMPART," Meurer says. "It's hard to say this can all be attributed to RAMPART. Perhaps people were already learning more about midazolam and its benefits, but it's encouraging to see EMS agencies embracing clinical trial results and knowledge gained through these trials."

The team also performed a secondary analysis for rates of airway interventions and rescue therapy for patients treated with midazolam and noted little change in those values from before and after RAMPART was published.

The future of midazolam

While midazolam is gaining traction in the seizure community, it has already been used for several years for lethal injections -- perhaps to the detriment of seizure patients.

"I'm fearful this important drug may suffer the same fate some of its fellow injections, such as sodium thiopental, have seen," Meurer says. "Drug companies aren't making enough money off of midazolam to make it worth the bad press it gets from executions."

Meurer hopes its benefits for patients will outweigh the negative attention, adding,

"I hope people will realize this drug is so much more widely used than sodium thiopental was and is incredibly beneficial to this patient population."
-end-


Michigan Medicine - University of Michigan

Related Seizures Articles:

Seizures follow similar path regardless of speed, says study
In a new study in Cell Reports, researchers at Columbia University show that the neurons of mice undergoing seizures fire off in a sequential pattern no matter how quickly the seizure propagates -- a finding that confirms seizures are not the result of neurons randomly going haywire.
Study could help explain link between seizures and psychiatric disorders
In a new study published in Cell Reports, scientists at the Gladstone Institutes identified different types of neurons in a brain region called the reticular thalamus.
Pinpointing where seizures are coming from, by looking between the seizures
A computational approach developed at Boston Children's Hospital, described in the journal Neurosurgery, published online May 2, 2017, could enable more patients with epilepsy to benefit from surgery when medications do not help.
'Silent seizures' discovered in patients with Alzheimer's disease
Deep in the brains of two patients with Alzheimer's disease, the main memory structure, the hippocampus, displays episodic seizure-like electrical activity.
Epilepsy -- why do seizures sometimes continue after surgery?
New research from the University of Liverpool, published in the journal Brain, has highlighted the potential reasons why many patients with severe epilepsy still continue to experience seizures even after surgery.
The heart-brain connection: The link between LQTS and seizures
Patients carrying certain mutations that cause Long QT Syndrome, a rare cardiac rhythm disorder, have an increased risk for developing seizures and have more severe cardiac symptoms.
Breast cancer drug found to reduce seizures
A class of drug that inhibits estrogen production and is used to treat breast cancer has been found to quickly and effectively suppress dangerous brain seizures, according to a new Northwestern University study.
Study suggests new treatment for seizures
Researchers from Northwestern University, Evanston, Ill., have discovered a new factor in the escalation of seizures: the synthesis, or generation, of estrogens in the brain.
Minisensor is designed to warn of epileptic seizures
For epilepsy patients and attending physicians, it has been a challenge to correctly assess the frequency and severity of epileptic seizures without inpatient recording equipment.
Many stroke survivors may develop seizures
A substantial proportion of stroke survivors develop seizures in the years following their strokes, according to research presented at the American Stroke Association's International Stroke Conference 2016.

Related Seizures Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...