ABSTRACT
A telephone survey was carried out to evaluate the effectiveness and convenience of nasal/buccal midazolam in terminating prolonged seizures in the community. A total of 33/40 (83%) families who had used it found it effective and easy to use; 20/24 (83%) preferred using midazolam to rectal diazepam.
Subject(s)
Anticonvulsants/administration & dosage , Midazolam/administration & dosage , Seizures/drug therapy , Administration, Buccal , Administration, Intranasal , Adolescent , Adult , Child , Child, Preschool , Humans , InfantABSTRACT
OBJECTIVE: To review effects of the vehicle of lorazepam, propylene glycol, in regard to lactate, osmolarity, and renal dysfunction. DESIGN: Case report. SETTING: Intensive care unit of a Level I trauma center. Patient A 36-yr-old Hispanic man who developed severe respiratory failure and required high-dose lorazepam for sedation. The patient was ventilated with low tidal volumes in a lung-protective fashion, with resultant "permissive hypercapnia." Lactates and osmolalities rose on initiation and fell, as expected, on discontinuation of the lorazepam infusion. However, there was no renal compensation for the hypercapnia except while the patient was not receiving lorazepam. MEASUREMENTS AND MAIN RESULT: Serial osmolalities, lactates, serum bicarbonate, PaCO2, and pH were measured during lorazepam infusion. Rise and fall of serum lactate and osmolality closely correlated with lorazepam. Serum bicarbonate rose significantly while the patient was not receiving lorazepam in response to hypercarbia and failed to rise while the patient was receiving lorazepam. CONCLUSION: The vehicle of lorazepam, propylene glycol, can cause hyperlactatemia and elevated osmolar gaps. However, propylene glycol may also interfere with renal tubular function and may blunt renal compensation for respiratory acidosis.
Subject(s)
Conscious Sedation , Kidney Tubules/drug effects , Lactic Acid/blood , Lorazepam/adverse effects , Propylene Glycol/adverse effects , Respiration, Artificial , Water-Electrolyte Balance/drug effects , Adult , Bicarbonates/blood , Humans , Infusions, Intravenous , Lorazepam/administration & dosage , Male , Myocardial Infarction/physiopathology , Myocardial Infarction/therapy , Pharmaceutical Vehicles , Propylene Glycol/administration & dosage , Water-Electrolyte Balance/physiologyABSTRACT
A series of 25 children, 13 females and 12 males, who had an acquired communication disorder together with epilepsy, but did not fulfil the strict criteria of the Landau-Kleffner syndrome, was studied. All children had a clinical neurological evaluation, speech and language assessment, an awake and sleep EEG, cranial MRI, SPET scan, and audiometry. Clinical seizures were most often polymorphic in type (17 of 25). Atypical absences were the commonest individual seizure type occurring in 15 cases. All patients had an unequivocal epileptiform EEG. Normal sleep phenomena were only observed in 10 cases, enhancement of epileptiform activity in sleep was seen in 16. Cranial MRI was abnormal in six and normal in 19 cases. The SPET scans were abnormal in 22 of 25 children. The language deficits were classified neurologically as receptive aphasia, 24 of 25; expressive aphasia, 20 of 25; nominal aphasia, eight of 25; articulatory dyspraxia, 10 of 25; and auditory agnosia, nine of 25. It is hypothesized that the loss of communication skills is due to an encephalopathy secondary to the persistent epileptic discharge and manifests as a hypometabolic area on the SPET scan.
Subject(s)
Aphasia/etiology , Brain/metabolism , Epilepsy/etiology , Metabolism, Inborn Errors/complications , Adolescent , Anticonvulsants/therapeutic use , Aphasia/diagnosis , Brain/diagnostic imaging , Brain/pathology , Child , Child, Preschool , Electroencephalography , Epilepsy/drug therapy , Female , Humans , Magnetic Resonance Imaging , Male , Metabolism, Inborn Errors/diagnosis , Tomography, Emission-Computed, Single-PhotonABSTRACT
Adrenocorticotrophin hormone (ACTH) has been used as an anticonvulsant for many years. In this paper, the use of ACTH in 23 children with intractable epilepsies is described. It was found that ACTH worked most effectively when the EEG showed benzodiazepine sensitivity. A mechanism of action of ACTH is proposed.
Subject(s)
Adrenocorticotropic Hormone/adverse effects , Anticonvulsants/adverse effects , Epilepsy/drug therapy , Adenosine/metabolism , Adrenocorticotropic Hormone/pharmacology , Anticonvulsants/pharmacology , Benzodiazepines/therapeutic use , Binding Sites , Child , Child, Preschool , Cohort Studies , Diazepam/therapeutic use , Electroencephalography , Epilepsy/diagnosis , Female , Follow-Up Studies , Humans , Infant , Male , Receptors, GABA-A/drug effects , Severity of Illness Index , gamma-Aminobutyric Acid/metabolismABSTRACT
Non-convulsive status epilepticus (NCSE) is a common complication of the childhood epileptic encephalopathies. An essential feature for the diagnosis of non-convulsive status epilepticus is a continuous epileptiform activity on the electroencephalogram (EEG). Dementia is thought to be a possible long-term sequel of non-convulsive status epilepticus, the mechanism of which has remained elusive. Neuron specific enolase is a marker of neuronal damage. The serum concentration of neuron specific enolase (sNSE) has been measured in 17 children with continuous epileptiform activity on the EEG and in 16 children with epilepsy but without a continuous dysrhythmia. There was a significant difference in the concentration of sNSE between the two groups.
Subject(s)
Brain Diseases, Metabolic/enzymology , Brain Diseases, Metabolic/physiopathology , Electroencephalography , Nerve Degeneration/enzymology , Nerve Degeneration/physiopathology , Phosphopyruvate Hydratase/blood , Status Epilepticus/diagnosis , Adolescent , Biomarkers , Brain Diseases, Metabolic/pathology , Child , Child, Preschool , Female , Humans , Infant , Male , Nerve Degeneration/pathology , Status Epilepticus/etiologyABSTRACT
Benzodiazepines are routinely used by the rectal route for the treatment of acute epileptic seizures: if a benzodiazepine was absorbed from nasal administration this could provide a more acceptable alternative to rectal administration. Nineteen children (age range 7 months to 14 years) with intractable epilepsy were chosen. The EEG's showed unequivocal epileptic activity persisting during the recording. The midazolam was dripped slowly into the anterior nares. Fifteen had a positive response, a dramatic improvement in their EEG or cessation of fits. Drug induced beta activity occurred in 14 children. The mean time to appearance of beta activity was 111.5 secs (SD = 95.3 secs). The reduction in spike count pre and post midazolam was statistically significant (p < 0.01). The improvement in EEG background was also statistically significant. Midazolam is absorbed via the i.n. route. With the dosages used it suppressed epileptic activity and produced an improvement in EEG background. The children and parents found the method acceptable. This is the first study to use the i.n. route for anti-convulsant drugs.
