Abstracts

Despite adherence to a medication regimen, many patients with epilepsy continue to experience breakthrough seizures that result in time consuming and costly visits to the emergency department (ED). These case reports examine the effectiveness of diazepam rectal gel in reducing the number of ED visits for adult patients with refractory seizures. Patient charts were reviewed from 1999 to present to compare the number of ED visits before and after starting diazepam rectal gel for treatment of breakthrough seizures. Prior to receiving diazepam rectal gel, 5 patients visited the ED a total of 37 times. Patient 1, a 32-year-old woman with recurrent seizures, continued to have breakthrough seizures necessitating ED visits despite trying multiple medications and implantation of a vagus nerve stimulator. She had 4 ED visits in 2001 and 6 visits in 2002. Patient 2, a 41-year-old man, has experienced seizures since childhood, which are inadequately controlled on his current regimen of carbamazepine and levetiracetam. He visited the ED twice in 2000 and 3 times in both 2001 and 2002. Patient 3 is a 55-year-old man taking carbamazepine and lamotrigine for postencephalitic seizures. This patient visited the ED twice in 1999 and 2000 and 4 times in 2001. Patient 4, a 39-year-old woman taking oxcarbazepine and zonisamide for her idiopathic seizures, visited the ED 3 times in 2001. Following the use of diazepam rectal gel for breakthrough seizures beginning in 2003, none of these patients has visited the ED. One additional patient, a 24-year-old man, visited the ED 3 times in 2000, once in 2001, and 4 times in 2002 when carbamazepine and levetiracetam failed to control posttraumatic seizures. Since starting diazepam rectal gel in 2003, this patient has visited the ED only once. Mild sedation was the only reported adverse event. Diazepam rectal gel effectively treated breakthrough seizures in these patients. Use of diazepam rectal gel is associated with dramatic reduction in the combined total number of ED visits from 37 to 1 and entirely eliminated the need for ED visits in 4 of 5 patients. (Supported by Xcel Pharmaceuticals)