Seizure treatment en route to hospital safe and effective, study shows

August 29, 2001

Potentially life threatening seizures can be safely treated by paramedics using injections of Valium or similar benzodiazepine drugs en route to the hospital, rather than waiting for hospital staff to administer the drugs, according to a new study led by researchers at the University of California, San Francisco.

The likelihood of brain damage is reduced if seizures are stopped quickly - preferably within 30 minutes of onset, and many paramedic units already administer benzodiazepines, bolstered by anecdotal evidence that they are effective in stopping seizures before reaching the hospital, the researches note. But benzodiazepines can cause some people to stop breathing, breathe too shallowly or can cause cardiac complications, and emergency medical vehicles lack the full range of support measures available in hospitals to respond to these events.

The new study is the first to systematically examine the benefits of early administration of modest doses of benzodiazepines by paramedics and determine if the benefits clearly outweigh potential serious side effects.

The findings are published in the August 30 issue of The New England Journal of Medicine. Lead author is Brian Alldredge, PharmD, UCSF professor of clinical pharmacy and clinical professor of neurology.

The study is based on 205 patients diagnosed with "status epilepticus," continuous or repeated seizures lasting at least five minutes without recovery of consciousness. About half the people in the study had seizures as a result of epilepsy, and about half experienced seizures from other causes, such as alcohol abuse, adverse drug reactions, stroke or head trauma, Alldredge said.

Those who received the anti-seizure drugs in the ambulance were far more likely to be free of seizures by the time they reached the hospital than were those who remained unmedicated en route, the researchers found.

Although diazepam --also know as Valium -- is currently the drug of choice used by paramedics to treat someone with a prolonged seizure, lorazepam, a related drug also in the benzodiazepine class, was found to be at least as effective and possibly more so, the study found. While 43 percent of those given five-to-ten-milligram diazepam injections were seizure-free upon arrival at the hospital, almost 60 percent of those given comparable doses of lorazepam were free of their seizures. The differences between the two drugs, while striking, were not found to be statistically significant because of the relatively small number of people in the study. By contrast with the two drug-treated groups, only 21 percent of the unmedicated group were seizure free by the time they reached the hospital.

"This study will reassure many EMS systems that treatment with benzodizepines is both safe and effective," Alldredge said. "It suggests too that lorazepam is likely to be a better choice than diazepam. Lorazepam is not as stable as diazepam in warm climates, so in hot areas, it might be necessary to install refrigeration units on ambulances."

In future studies Alldredge intends to explore the effectiveness of other forms of intervention, such as increased doses of the drugs, since many of the patients were still experiencing seizures when they arrived at the hospital. He also wants to include studies of other drug delivery routes, such as intramuscular injections, which are easier to administer than intravenous injections.
Senior author on the study is Daniel H. Lowenstein, MD, dean of medical education at Harvard Medical School who was a UCSF professor of neurology when the study was undertaken.

Co- authors are Alan Gelb, MD, UCSF clinical professor of medicine and chief of the emergency services at San Francisco General Hospital Medical Center (SFGHMC); S. Marshal Isaacs, MD, UCSF associate clinical professor of medicine; and Nelda O'Neil, RN, MSN, UCSF clinical nurse, both also in SFGHMC emergency services.

Other researchers are Megan D. Corry, EMT-P, Emergency Medical Services, San Francisco Fire Department; Faith Allen, MD, staff research associate in neurology, UCSF; John M Neuhaus, PhD and Mark R. Segal, PhD, both UCSF professors of epidemiology and biostatistics; and Mildred D. Gottwald, PharmD, assistant clinical professor of pharmacy, UCSF; and SueKay Ulrich, RN, of the Carondelet Health Network in Tucson, Arizona.

Isaacs is also medical director of the Emergency Medical Services Division of the San Francisco Fire Department.

The study was funded by the National Institute of Neurological Disorders and Stroke.

University of California - San Francisco

Related Seizures Articles from Brightsurf:

Hallucinations in people with seizures may point to suicide risk
A study from scientists at Trinity College Dublin and Royal College of Surgeons in Ireland shows that 8% of individuals with a history of seizures report hallucinations, including experiences of hearing or seeing things that are not based in reality.

Epilepsy: Seizures not forecastable as expected
Epileptic seizures can probably not be predicted by changes in brain wave patterns that were previously assumed to be characteristic precursors.

Predicting epileptic seizures might be more difficult than previously thought
By studying the brain dynamics of 28 subjects with epilepsy, scientists demonstrated there is no evidence for a previously suspected warning sign for seizures known as 'critical slowing down,' which refers to characteristic changes in the behavior of a complex system that approaches a theoretical tipping point; when this point is exceeded, there can be impactful and devastating changes.

Gene protective against fruit fly heat-induced seizures may explain some human seizures
Researchers identified a gene in fruit flies that helps prevent the hyperexcitability of specific neurons that trigger seizures.

Rethinking seizures associated with cardiac disease
Research from Washington University in St. Louis finds that mutations of a gene implicated in long QT syndrome in humans may trigger seizures because of their direct effects on certain classes of neurons in the brain -- independent from what the genetic mutations do to heart function.

UTSA reduces seizures by removing newborn neurons
Epileptic seizures happen in one of every 10 people who have experienced a traumatic brain injury (TBI).

Reducing seizures by removing newborn neurons
Removing new neurons born after a brain injury reduces seizures in mice, according to new research in JNeurosci.

Inducing seizures to stop seizures
Surgery is the only way to stop seizures in 30 per cent of patients with focal drug-resistant epilepsy.

New research could help predict seizures before they happen
A new study has found a pattern of molecules that appear in the blood before a seizure happens.

New drug could help treat neonatal seizures
A new drug that inhibits neonatal seizures in rodent models could open up new avenues for the treatment of epilepsy in human newborns.

Read More: Seizures News and Seizures Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to