Epi-Pen to Stop Epileptic Seizures?

February 15, 2012— -- The longer an epileptic seizure lasts, the more likely it is to turn deadly.

Besides administering an oral or anal gel suppository – which can be difficult to give successfully in the midst of a seizure – caregivers are at a race against time, with little to do but wait for paramedics to arrive.

But researchers through the National Institute of Neurological Disorders and Stroke, a branch of the National Institutes of Health, say creating an injectible pen to stop seizures -- much like the popular EpiPen used widely for treating acute allergic reactions - may prove to be a lifesaver.

In a new study, published Wednesday in the New England Journal of Medicine, researchers found that injecting emergency anti-seizure medication into the muscle can stop prolonged seizures -- those seizures that last for five minutes or longer -- faster than if it were administered through an IV line administered by a paramedic.

Nearly 900 patients with epilepsy who experienced seizures lasting longer than five minutes, either were given a shot in the muscle with the anticonvulsant midazolam by paramedics, or the standard IV line of the anticonvulsant drug lorazepam.

On average, the seizures were shorter for those patients who were administered a shot of midazolam directly into the muscle, lasting just 1 1/2 minutes after the medication was injected. Patients who received anticonvulsant drugs by IV drip, by contrast, suffered longer seizures, which continued on average for as long as five minutes before the treatment took effect.

Nearly 55,000 people die each year from prolonged seizures, according to Dr. Robert Silbergleit, emergency physician at the University of Michigan Health System, and lead author of the study.

"It's difficult to start an IV in somebody who's having convulsions, who's shaking, and that difficulty can cause a delay in getting the IV started, which can cause a delay in stopping the seizure," said Silbergleit. "And it can also be a safety hazard for the paramedic who's got a sharp object and a shaking patient," he said.

Although paramedics administered the shot to patients in the study, the findings could pave the way for a shot that can be administered by caregivers before paramedics even arrive, according to Dr. Jason McMullan, assistant professor of clinical emergency medicine at the University of Cincinnati and co-investigator of the study.

"The earlier they are treated, the sooner the seizure will stop, the easier it will be to control and the better the outcome," said McMullan.

The study enrolled adults and children as young as 2 years old.

"Most seizures stop on their own without any type of medication," said McMullan, adding that the findings only apply to those who have prolonged seizures, known as status epilepticus.

Midazolam, one drug in a class of medications called benzodiazepines, can be used to stop seizures. Other benzodiazepines, diazapem and lorazepem are anticonvulsants currently used anally and in IV form, respectively.

"I am very excited that this is another tool in the arsenal for present lifesaving treatments for prolonged seizures," said McMullan.

Although midazolam currently is used off-label to stop seizures, syringes with a standard dose of the medication – such as those used in the study -- are not currently approved by the U.S. Food and Drug Administration.

While it might take a while until an auto-injector "epi-pen" of the medication is approved for caregivers, McMullan said paramedics can use the technique now.

"They can draw it up in a syringe and use it as a shot, just like how medications are given," said McMullan.