Home Use of Buccal Lorazepam for Break-Through Seizures in Children
Abstract number :
2.172
Submission category :
Antiepileptic Drugs-Pediatrics
Year :
2006
Submission ID :
6611
Source :
www.aesnet.org
Presentation date :
12/1/2006 12:00:00 AM
Published date :
Nov 30, 2006, 06:00 AM
Authors :
1Curtis S. Claassen, 1,2Lorie D. Hamiwka, 1Marlene A. Blackman, and 1,2Elaine C. Wirrell
To determine the effectiveness and tolerability of home use of buccal lorazepam for break-through seizures in children., Children prescribed lorazepam by the Neurology Service at the Alberta Children[apos]s Hospital in 2005 were identified retrospectively. Charts were reviewed to determine seizure type(s), frequency, syndrome, prior and current AED use, prior status epilepticus, age at onset, gender, cognitive status and age at prescription of lorazepam. Families were contacted in May 2006 and queried regarding number of lorazepam doses used, effectiveness and adverse effects., Twenty one patients were identified (8M, 13F, mean age 7.1 yrs, range 0.5-15.9) who were prescribed lorazepam. Fourteen (67%) had a history of status epilepticus. Nineteen (90%) had symptomatic partial epilepsy, while 1 patient each had idiopathic generalized epilepsy and febrile status epilepticus.
Thirteen patients (62%) received a test dose and the remainder had previous exposure to a therapeutic dose of benzodiazepine either in the ER or given by EMS. At follow-up, 11 (52%) had used lorazepam (median # doses 2, 25th-75th%ile 1-9). Therapeutic effectiveness was 100% in 5 (45%), 80% in 2 (18%), 50% in 2 (18%) and 0% in 2 (18%). Of the 9 patients reporting some success with lorazepam, median time to seizure cessation was 4 minutes (25th-75th%ile 2-9 mins). No child experienced a significant adverse effect. Five had transient, minor irritability and 3 had mild sedation. No child had respiratory problems related to lorazepam, although one child with profound ictal apnea failed to respond to lorazepam and continued to be apneic.
Patient age, seizure syndrome, cognitive status or number of prior AEDs were not predictive of response. However, children on prophylactic benzodiazepines tended to have a lower response rate than those not taking these agents (1/3 vs 6/8, p=0.28)., Buccal lorazepam appears to be a safe, efficacious and cost-effective therapy for home-use in children with break-through seizures. Children on prophylactic benzodiazepines may have a lower response rate, however larger subject numbers are needed to confirm this finding.,
Antiepileptic Drugs