Nasal Therapy for Seizure Emergencies

Wednesday, September 23, 2015

People with epilepsy know that seizures can be unpredictable. Being prepared can help reduce both the potential for injury and anxiety. Developing a Seizure Response Plan is an important component for success in managing epilepsy. A part of that plan may include a discussion with your medical team about medications that are taken in a response to a seizure.

About Rescue Medicines

Currently, the most widely available medications for people to use as "Rescue Medicines" are in the class of medications known as the benzodiazepines. Examples of medications in this class include diazepam (Valium®), lorazepam (Ativan®), and midazolam (Versed®). People are prescribed these medications for varying reasons, including anxiety and sedation during medical procedures. Physicians also use benzodiazepines for symptoms of nausea, muscle spasms, headache, and insomnia, even though the U.S. Food and Drug Administration (FDA) has not labeled the above benzodiazepines for those exact symptoms.

Benzodiazepines are, however, FDA approved for seizures. These medications work to reduce the activity of nerve cells that are overactive, which is what occurs in your brain during a seizure. Benzodiazepines attach to receptors on the surface of a nerve cell, decreasing the chance for that specific cell to transmit further signals to other nerve cells. When a nerve cell stops transmitting extra signals that occur during a seizure, seizures stop. This process is what makes benzodiazepines so effective for seizures.

What are the challenges with rescue medications?

Despite the many benefits of benzodiazepines, there are also several drawbacks. Since benzodiazepines calm down excessive electrical transmission in the brain, they can also cause people to become sleepy, slow down their ability to think, and, if taken in excess, may even reduce a person's ability to breathe. For these reasons, benzodiazepines should always be taken exactly as prescribed by a physician. If you are not clear about how much or how often you can take your benzodiazepine, please ask your doctor. As with all medications, benzodiazepines should only be taken as instructed and can be life-threatening if taken in excess.

One of the biggest challenges using "rescue medications" when someone is having a seizure is the issue of being able to safely administer it to the person. All of the benzodiazepines are available in a pill form, and only diazepam is available in a rectal gel (Diastat® AcuDial™). When having a seizure, many individuals are physically unable to swallow a pill. Although not specifically FDA-approved for seizures, clonazepam is available in an oral dissolving tablet (ODT). This ODT is absorbed through the lining of the mouth and does not need to be swallowed. However, caution should be used if attempting to place anything in the mouth of a person having a seizure. Furthermore, for many people with epilepsy and their caregivers, administration of a medication into the rectum during a seizure may also not be practical.

Nasal Therapy: A Potential Solution for Seizure Emergenices

Spraying a benzodiazepine into someone's nose may potentially be one of the most sensible solutions for people with seizures. It has been established that medications can be easily absorbed in the lining of the nasal cavity (such as allergy medications and certain vaccinations). For well over a decade, many different researchers have attempted to develop a benzodiazepine that can be reliably and effectively sprayed into the nose of someone who is having a seizure. Some physicians have been using liquid forms of benzodiazepines and instructing their patients to administer the liquid medicine into the nasal cavity (which is not FDA-approved). These liquid forms of benzodiazepines typically need to be provided through specialty pharmacies.

Over the last couple of years, there has been rising interest in developing an FDA-approved benzodiazepine nasal spray. Currently, there are benzodiazepine nasal spray clinical trials underway for people with seizures. These trials are typically enrolling people with "seizure clusters" (i.e., people who typically have multiple seizures in a row). Over the next year or two, there is an expectation that a benzodiazepine nasal spray will be approved by the FDA and made available to people with epilepsy.

Prepare for a Seizure Emergency

All people with epilepsy should have a Seizure Response Plan. If you feel that your epilepsy would benefit from a rescue medication, speak to your medical team about it. Again, being prepared is one of the best ways to reduce the fear of seizures and keep you safe.

Please come back to frequently for updates as new medications become available.

Authored by: Matthew Hoerth MD | Seizure Emergency Editor on 9/2015

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