Abstracts

Many patients experiencing spasticity associated with brain and spinal injuries, cerebral palsy, and multiple sclerosis may also have epilepsy diagnoses. Breakthrough seizures, if left untreated, may pose a serious health risk, potentially causing long-term neuronal damage. For patients living in rural or medically underserved areas, a one-way trip to the clinic could take from 2 to 5 hours. Therefore, a rescue alternative is critical for seizure emergencies. Diazepam rectal gel, a portable rescue medication, has demonstrated efficacy in the at-home management of breakthrough seizures for various populations who experience seizures. Our clinic also uses it as part of a rescue protocol for pump refill and pump failure emergencies in patients with intrathecal baclofen (ITB) pumps. Diazepam rectal gel may play a critical role in providing effective treatment for both seizure and pump emergencies for this group of patients. The current study investigated the efficacy of diazepam rectal gel in treating breakthrough seizures in patients who have ITB pumps. We reviewed the charts of patients with ITB pumps, identified patients with a diagnosis of epilepsy, and examined their use of diazepam rectal gel treatment for seizure emergencies. In this primarily pediatric population, of 80 patients treated with ITB, 24 also had epilepsy diagnoses. Ten patients were female, 14 male; mean patient age was 14.3 years (range, 7-23 years). Among these patients with head injury, cerebral palsy, and static encephalopathy, seizure diagnoses were generalized tonic-clinic (17 patients), complex partial (6), and absence (1). Eighteen of the 24 patients experienced seizure emergencies and were treated with diazepam rectal gel. For all 18 patients, diazepam rectal gel successfully terminated the seizure. No adverse events were reported. Diazepam rectal gel effectively terminated breakthrough seizures in this patient population. Because it may be administered at home by nonmedically trained caregivers, diazepam rectal gel provides an especially valuable management option for breakthrough seizures in these patients. Given that many of the patients live in rural and medically underserved communities where travel to the nearest hospital may take several hours, a portable rescue medication for seizure emergencies is vitally important. (Supported by Xcel Pharmaceuticals)