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NIH study finds safe method to treat prolonged seizures

Drug delivery into muscle using an autoinjector, akin to the EpiPen used to treat serious allergic reactions, is faster and may be a more effective way to stop status epilepticus, a prolonged seizure lasting longer than five minutes, according to a study sponsored by the National Institutes of Health.

Joseph Ornato, M.D., chair of VCU’s Department of Emergency Medicine, was principal investigator of the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) study for the VCU Neurological Emergencies Treatment Trials site – one of 17 sites in a consortium examining potential new therapies for the most common and devastating neurological emergencies.

The investigators compared two medicines known to be effective in controlling seizures, Midazolam and Lorazepam. Both are benzodiazepines, a class of sedating anticonvulsant drugs, or medications used in the treatment of epileptic seizures.

The researchers sought to determine whether an intramuscular injection, which quickly delivers anticonvulsant medicine into a patient’s thigh muscle, is as safe and effective as giving medicine directly into a vein. The study was carried out by paramedics and compared how well delivery by each method stopped patients’ seizures by the time the ambulance arrived at the emergency department.

According to Ornato, the study showed that an intramuscular injection of Midazolam using an autoinjector is at least as good, and for some endpoints, better than the standard intravenous Lorazepam in stopping seizures.

“This is critical because paramedics are unable to start an IV in a significant percentage of patients who are seizing because of their shaking movements,” said Ornato. “Of note, clinically significant adverse effects were not more frequent with the intramuscular Midazolam. This study has the strong potential to change the standard of care nationally with respect to how we treat seizure patients.”

To view the official release, visit http://www.ninds.nih.gov/news_and_events/news_articles/RAMPART_results.htm.

Joseph P. Ornato, M.D.
Joseph P. Ornato, M.D.