Abstracts

Emergency department (ED) visits for seizures are associated with morbidity and cost. Rectal diazepam gel is being prescibed for children with prolonged or repetitive seizures for home use. This prospective study investigated ED use before and after parents were prescribed rectal diazepam gel for their children.
Between May 1999 and April 2001, families of children 12 years and younger who were prescribed rectal diazepam gel for the first time were asked to participate in this study. Care givers were instructed in the proper method of administration and in the identification of situations in which the medication should be used. Information regarding medication usage, seizure activity, and ED visits for the six month period preceding and following the prescribing or rectal diazepam gel was obtained. Assessments of stress and quality of life were obtained at baseline and at 6 months. There were 45 eligible subjects, 39 of whom agreed to participate in the study. Sufficient data for analysis was available on 38 cases.
Of the 38 children, 25 (66%) had epilepsy and 13 (34%) had febrile seizures. In the 6 months prior to study entry, 34 (89%) had at least one ED visit with a total of 48 ED visits in these children. In the 6 months following study entry, 19 (50%) children had further seizures including 16 (64%) of those with epilepsy and 3 (23%) with febrile seizures. Rectal diazepam gel was administered to 8 children, all with epilepsy, a total of 15 times. There were no cases of respiratory depression. Of the 15 times, seizures stopped and no ED visit was required in 12. An ED visit was required for continued seizure activity in 2 children on 3 occasions. In one child it was used once without success. In the other child, who had intractable epilepsy and multiple prior ED visits, it was used 4 times and was unsuccessful twice. In addition there were 4 ED visits in 3 children due to seizures where rectal diazepam was not administered. In two of those children rectal diazepam was never given depspite being prescribed. In the third, it was not given twice and the child was taken to the ED but the third time it was successfully used . In one case, the inforrmation on whether rectal diazepam was given or not was not available.
Prolonged or repetitive seizures may require management in the ED. This is not optimal as it delays the inititation of therapy and is associated with significant morbidity and cost. As seizures may stop spontaneously, an observational trial such as this can not assess efficacy in the sense of stopping seizures. However, these data do demonstrate that home use of rectal diazepam gel prevented the need for an ED visit with its attendant morbidity and costs in a substantial proportion of cases.
[Supported by: Research grant from Elan Pharmaceuticals.]