Study: New Treatment Better for Epilepsy
LONDON — New research promises people with epilepsy a more effective – and more dignified – method of stopping prolonged convulsions so that they don’t have to just ride it out or be taken to a hospital emergency room.
In the largest study to date comparing treatments, scientists found that a new method – infusing a tranquilizer into the mouth between the gums and cheek – worked twice as well as the traditional method of squirting the medicine into the rectum.
Experts said the findings, published this week in The Lancet medical journal, represent an important step forward in the care of people with epilepsy.
"This study involved exceptional seizures, but I think the medication will be much more widely used," said Dr. Gregory Barkley, chairman of the professional advisory board of the Epilepsy Foundation in the United States. "If it is cheap and easy to administer, I would think most people with epilepsy would like to have medication like this available for emergencies – a little extra insurance."
About 40 million people worldwide have epilepsy, a condition that makes people susceptible to seizures, which are brought on by a brief electrical disturbance in the brain. Seizures range in severity from a barely noticeable disruption of the senses to convulsions.
The condition is managed primarily with drugs. Most people become seizure-free with the right drugs, but in about 20 percent of cases, seizures persist despite medication.
Most of the time, the convulsions subside within a minute or two, but they can last much longer, carrying the risk of brain damage or even death.
Tranquilizers such as Valium are normally used to stop such seizures. In the emergency room, the drugs are given intravenously to adults, but in children one of the drugs – diazepam – is often given in the rectum. That’s been standard practice for decades.
Similarly, patients and their carers have had the option of using the rectal treatment at home as an emergency intervention. That option is not popular with adolescents or adults, but many parents carry it in case their children have a convulsion that doesn’t subside within five minutes.
Pills are available, but they take about half an hour to kick in because they are absorbed through the digestive system and some patients aren’t able to swallow during a convulsion.
In the study, doctors from several hospitals in England compared the rectal and mouth treatments in 219 convulsions involving 177 children who were brought to the emergency room with a long-lasting seizure. Not all the children had epilepsy. Some were having convulsions related to fever.
The doctors evaluated how successful each treatment was at stopping the seizures within 10 minutes and sustaining the siezure-free state for at least an hour.
The mouth treatment, which used the liquid tranquilizer midazolam, worked twice as well as the rectal approach, which used liquid diazepam, or Valium. Both drugs, from the same family of sedatives, are considered to have the same action.
The mouth treatment was successful in 61 out of 109 cases, or 57 percent of the time, while the rectal infusion worked in 30 out of 110 cases, or 27 percent of the time.
The mouth treatment also kicked in more quickly and lasted longer, the study found.
"This is a findings that’s likely to be used extensively. I anticipate we will employ this extensively," said the Epilepsy Foundation’s Barkley, who was not connected with the research.
The mouth treatment has already gained some popularity in Europe, following earlier studies indicating it was at least as effective as the rectal option, said Dr. John Duncan, medical director of the National Society for Epilepsy and head of epilepsy services at the National Hospital for Neurology and Neurosurgery in London.
However, it is not as widely adopted as it could be because the midazolam is licensed only for intravenous administration, not oral, he added.
Studies are planned in Europe to test a nasal spray, which experts say may be an even better option.