Stopping seizures with a pen

Every two minutes someone in the US dies from a neurological emergency. In fact, seizures are one of the most common reasons for ambulance runs. Now a new simple device could help save time and lives.

Seizures come on suddenly affecting one in 100 people or 2.5 million Americans.

Delmetria Grant is one of them. She began having seizures more than a decade ago.

"It's frightening because you don't know what's going to happen, when it's going to happen," explains Delmetria Grant.

While most don't last longer than a minute, those with prolonged seizures risk brain damage and death.

"So we know that the faster we can administer some treatment for them, the more likely that person is to stop seizing and to recover from that," explains Dr. Tricia Ting Assistant Professor of Neurology at the University of Maryland School of Medicine.

Dr. Tricia Ting says the current standard of care for patients is through an IV.

"But you can imagine how difficult it is when they are trying to access an IV in someone that may be convulsing and moving their arm around,” says Dr. Ting.

That's why the doctor and her team at the University of Maryland School of Medicine participated in a national trial to test this new auto-injector. It's similar to the epi-pen used to treat serious allergic reactions.

Results from the National Institutes of Health study show 73 percent of patients who received injected seizure medicine were seizure-free when they got to the hospital versus 63 percent of patients who received IV treatment.

"This is a proven therapy to work to stop seizures that are prolonged and dangerous,” says Dr. Ting.

Now Dr. Ting says it's only a matter of time before the auto-injectors are in the hands of patients and their families to stop seizures even sooner.

About 55,000 deaths are attributed to prolonged seizures.

While it might take a while until an auto-injector epi-pen is approved for caregivers, paramedics can use the auto-injector right now.


REPORT: MB# 3470

BACKGROUND: Status epilepticus is a prolonged seizure lasting longer than five minutes. Status epilepticus is a potentially life-threatening emergency that causes 55,000 deaths each year. Anticonvulsant drugs are typically delivered intravenously (IV) as a first line of treatment. This has challenges though. Placing an IV in a patient having seizures can be difficult for paramedics and waste valuable time. An intramuscular shot is easier, faster and more reliable.

RAMPART STUDY: The Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) is the first randomized clinical trial to investigate whether intramuscular delivery of midazolam is as effective as IV lorazepam, the current standard of care therapy.

RAMPART was conducted through the NINDS' Neurological Emergencies Treatment Trials (NETT) network. Paramedics compared how well delivery by each method stopped patients' seizures by the time the ambulance arrived at the emergency department. The investigators compared two medicines known to be effective in controlling seizures, midazolam and lorazepam. Midazolam was a candidate for injection because it is rapidly absorbed from muscle. But lorazepam must be given by IV. The study found that 73 percent of patients in the group receiving midazolam were seizure-free upon arrival at the hospital, compared to 63 percent of patients who received IV treatment with lorazepam. Patients treated with midazolam were also less likely to require hospitalization than those receiving IV lorazepam. Among those admitted, both groups had similarly low rates of recurrent seizures.

The trial started in 2009 and completed enrollment in June, 2011. RAMPART involved more than 79 hospitals, 33 emergency medical services agencies, more than 4,000 paramedics and 893 patients ranging in age from several months old to 103.

(SOURCE: New England Journal of Medicine)

THE FUTURE: While autoinjectors could someday be available for use by epilepsy patients and their families, more studies are required.

Mallet finger due to loss of central extensor tendon to the distal phalanx


Tricia Ting, MD
University of Maryland School of Medicine
(443) 838-8013

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