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Use of Emergency Medication in Adult Patients with Epilepsy: A Multicentre Cohort Study from Germany

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A Commentary to this article was published on 31 August 2018

Abstract

Background

Emergency treatment with benzodiazepines is indicated in prolonged seizures, seizure clusters and status epilepticus.

Objective

The aim of this study was to evaluate the use of emergency medication in adult patients with epilepsy.

Patients and Methods

All adult epilepsy patients attending the epilepsy outpatient clinics of the university hospitals in Frankfurt and Marburg in 2015 were asked to participate in this questionnaire-based, retrospective survey.

Results

A total of 481 patients with a mean age of 43.4 years (range 18–94 years, 54% female) participated in the study. Among them, 134 patients (27.9%) reported on the prescription of an emergency medication during the last year. Patients receiving emergency medication were younger and exhibited a lower age at epilepsy onset, a higher seizure frequency and a higher number of regularly taken antiepileptic drugs. The most frequently taken emergency drugs were oral lorazepam tablets (65.7%; n = 88 out of 134), followed by buccal midazolam (23.9%, n = 32) and rectal diazepam (17.9%, n = 24). The most common indications for administering the emergency medication were seizures continuing for several minutes (35.1%, n = 47), but almost the same number of patients (33.6%, n = 45) stated that the rescue medication was given during or after every seizure. Regarding adverse events, sedation was named as a major (18.7%, n = 25) or moderate (29.1%; n = 39) problem by a substantial number of patients. Difficulties in administration were reported by 17 (13%) patients. Two-thirds assessed the efficacy of their emergency medication as good (50.7%, n = 68) or as very good (15.7%, n = 21). For multivariate logistic regression analysis, aspects such as young age at onset, active epilepsy, structural etiology, presence of generalised tonic–clonic seizures, past medical history of status epilepticus and living with another person independently predicted prescription of emergency medication.

Conclusions

In most cases, unsuitable benzodiazepines with slow absorption due to oral administration were prescribed, or buccal midazolam solution was used off-label in adults. Furthermore, inappropriate use of emergency medication at every seizure was reported by a substantial number of participating patients.

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Acknowledgements

We are grateful to our patients and their legal representatives and caregivers for their participation, and to our colleagues and hospital staff for assistance in conducting the study. This work has been awarded a poster prize at the annual meeting of the Germany Neurological Society (DGN) 2017 in Leipzig.

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Authors and Affiliations

  1. Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16, Haus 95, 60528, Frankfurt am Main, Germany

    Jeannette Kadel, Sebastian Bauer, Anke M. Hermsen, Lara Kay, Karl Martin Klein, Philipp S. Reif, Felix Rosenow & Adam Strzelczyk

  2. Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany

    Sebastian Bauer, Ilka Immisch, Karl Martin Klein, Susanne Knake, Katja Menzler, Felix Rosenow & Adam Strzelczyk

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  1. Jeannette Kadel
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Corresponding author

Correspondence to Adam Strzelczyk.

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Funding

The study was supported by an unrestricted grant by Desitin Arzneimittel.

Conflict of interest

J. Kadel, S. Bauer, A. M. Hermsen, I. Immisch, L. Kay, P. S. Reif report no conflicts of interest. K. M. Klein reports personal fees from UCB, Eisai, GW Pharmaceuticals and Novartis, outside the submitted work. S. Knake reports personal fees from Desitin, Eisai, UCB, as well as support for scientific meetings from AD-tech, Desitin, Eisai, GW Pharmaceuticals, LivaNova, Nihon Kohden and Novartis outside the submitted work. K. Menzler reports honoraria as advisory board member from Eisai and UCB, outside the submitted work. F. Rosenow reports personal fees from Eisai, grants and personal fees from UCB, grants and personal fees from Desitin Pharma, personal fees and other from Novartis, personal fees from Medronic, personal fees from Cerbomed, personal fees from ViroPharma and Shire, grants from European Union, grants from Deutsche Forschungsgemeinschaft, outside the submitted work. A. Strzelczyk reports personal fees and grants from Desitin Arzneimittel, Eisai, LivaNova, Sage Therapeutics, UCB Pharma and Zogenix, outside the submitted work. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

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Kadel, J., Bauer, S., Hermsen, A.M. et al. Use of Emergency Medication in Adult Patients with Epilepsy: A Multicentre Cohort Study from Germany. CNS Drugs 32, 771–781 (2018). https://doi.org/10.1007/s40263-018-0544-2

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