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| Name | Class |
|---|---|
| Primary Children's Hospital | OTHER |
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The investigators will conduct a randomized controlled trial comparing the use of nasal midazolam, using a Mucosal Atomization Devise, to rectal diazepam for the treatment of acute seizure activity in children under the age of 18 years with epilepsy in the community setting. The primary hypothesis is that nasal midazolam will be more effective and have shorter seizure time compared to rectal diazepam in the community. The secondary hypotheses are that patients treated with nasal midazolam will have fewer respiratory complications, emergency department visits, and admissions.
Study Design: This is a prospective randomized controlled study.
Study Procedures: Parents/guardians will be provided with a stopwatch to help record seizure times on the "Parent Form". All parents of children who have a seizure lasting longer than five minutes will be randomized to treat their seizure with the study medication (either rectal diazepam or nasal midazolam). If a parent treats a child with a study medication for seizure activity they are required to call "911". Families will be instructed to only give one dose of the study medication. If the seizure persists, EMS may give a second medication and transport the patient to the ED as per their established protocol. All parents/guardians who participate in this study will be asked to fill out a "Pre-study Form" (to be filled out during enrollment into the study) and a "Parent Form" for every seizure that is treated with the study medication. They will be given a stamped returned envelope to return the questionnaire. Once the study medication is used once, they will be done with the study. Any further need of home rescue medications to treat acute seizure activity will be coordinated by their neurologist. If questions arise, a study coordinator will be available by phone. In addition, parents/guardians will be contacted by phone every two months and questioned at clinic visits to audit compliance of reporting of seizures/hospitalizations, adverse events and answer any questions that arise. The study packet also instructs all families to call the study coordinator immediately if any expected or unexpected complication occurs. The study coordinator will be called on all ED visits and hospitalizations. We will then collect and analyze adverse events to compare them between the two groups. Any ER visit or hospitalization will be considered an adverse event and will be analyzed for its relationship to the seizure or medication. All adverse events will be reported to the IRB. See Table 1 for doses for the two study medications.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intranasal Midazolam 0.2mg/kg | Active Comparator | GIve once for seizure longer than 5 minutes |
|
| Rectal Diazepam 0.3-0.5 mg/kg | Active Comparator | Given once for seizure longer than 5 minutes |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Midazolam | Drug | Intranasal Midazolam 0.2 mg/kg given once for seizures longer than 5 minutes. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Length of Seizure After Study Medication Administration | Length of seizure. | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Respiratory Depression Requiring Intubation | Respiratory depression was defined as intubation at Emergency Department discharge. | 24 hours |
| Number of Patients Who Needed Additional Medication to Treat the Seizure in the Emergency Department Within 24 Hours |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Maija Holsti, MD, MPH | University of Utah | Principal Investigator |
| Francis Filloux, MD | University of Utah | Study Chair |
| Jeff Schunk, MD | University of Utah | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Primary Children's Medical Center | Salt Lake City | Utah | 84113 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15367152 | Background | Harbord MG, Kyrkou NE, Kyrkou MR, Kay D, Coulthard KP. Use of intranasal midazolam to treat acute seizures in paediatric community settings. J Paediatr Child Health. 2004 Sep-Oct;40(9-10):556-8. doi: 10.1111/j.1440-1754.2004.00463.x. | |
| 11013800 | Background | Starreveld E, Starreveld AA. Status epilepticus. Current concepts and management. Can Fam Physician. 2000 Sep;46:1817-23. |
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Recruited from a pediatric Neurology clinic.
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| ID | Title | Description |
|---|---|---|
| FG000 | Intranasal Midazolam | 0.2 mg/kg Intranasal Midazolam for a seizure longer than 5 minutes |
| FG001 | Rectal Diazepam | 0.3-0.5 Rectal Diazepam for a seizure lasting longer than 5 minutes |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Intranasal Midazolam | 0.2 mg/kg Intranasal Midazolam for a seizure longer than 5 minutes |
| BG001 | Rectal Diazepam | 0.3-0.5 Rectal Diazepam for a seizure lasting longer than 5 minutes |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Length of Seizure After Study Medication Administration | Length of seizure. | Analysis was per protocol | Posted | Median | Inter-Quartile Range | Minutes | 24 hours |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Intranasal Midazolam | 0.2 mg/kg Intranasal Midazolam for a seizure longer than 5 minutes |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Intubation | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Maija Holsti, MD, MPH | DIvision of Pediatric Emergency Medicine | 801-587-7450 | maija.holsti@hsc.utah.edu |
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| ID | Term |
|---|---|
| D012640 | Seizures |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D008874 | Midazolam |
| D003975 | Diazepam |
| ID | Term |
|---|---|
| D001569 | Benzodiazepines |
| D001552 | Benzazepines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
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| Diazepam | Drug | Rectal Diazepam (Diastat) given once for seizure greater than 5 minutes. |
|
|
| 24 hours |
| Number of Patients Needed to be Seen or Treated in the Emergency Department for Their Seizure and Use of Study Medication. | 24 hours |
| Number of Patients That Were Admitted to the Hospital After Their Seizure and Use of Study Medication. | 24 hours |
| Number of Patients Who Had a Repeat Seizure Within 12 Hours After Their Seizure Who Used Study Medication | 12 hours |
| Respiratory Depression Requiring Oxygen at Discharge From the Emergency Department. | Respiratory depression was defined as requiring oxygen at discharge from the Emergency Department. | 24 hours |
| 10985999 | Background | Scheepers M, Scheepers B, Clarke M, Comish S, Ibitoye M. Is intranasal midazolam an effective rescue medication in adolescents and adults with severe epilepsy? Seizure. 2000 Sep;9(6):417-22. doi: 10.1053/seiz.2000.0425. |
| 10700542 | Background | Jeannet PY, Roulet E, Maeder-Ingvar M, Gehri M, Jutzi A, Deonna T. Home and hospital treatment of acute seizures in children with nasal midazolam. Eur J Paediatr Neurol. 1999;3(2):73-7. doi: 10.1053/ejpn.1999.0185. |
| 8340986 | Background | Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America's Working Group on Status Epilepticus. JAMA. 1993 Aug 18;270(7):854-9. |
| 9127414 | Background | Chamberlain JM, Altieri MA, Futterman C, Young GM, Ochsenschlager DW, Waisman Y. A prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children. Pediatr Emerg Care. 1997 Apr;13(2):92-4. doi: 10.1097/00006565-199704000-00002. |
| 11198507 | Background | Fisgin T, Gurer Y, Senbil N, Tezic T, Zorlu P, Okuyaz C, Akgun D. Nasal midazolam effects on childhood acute seizures. J Child Neurol. 2000 Dec;15(12):833-5. doi: 10.1177/088307380001501219. |
| 11952072 | Background | Fisgin T, Gurer Y, Tezic T, Senbil N, Zorlu P, Okuyaz C, Akgun D. Effects of intranasal midazolam and rectal diazepam on acute convulsions in children: prospective randomized study. J Child Neurol. 2002 Feb;17(2):123-6. doi: 10.1177/088307380201700206. |
| 11042416 | Background | Kutlu NO, Yakinci C, Dogrul M, Durmaz Y. Intranasal midazolam for prolonged convulsive seizures. Brain Dev. 2000 Sep;22(6):359-61. doi: 10.1016/s0387-7604(00)00155-8. |
| 10884257 | Background | Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M. Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study. BMJ. 2000 Jul 8;321(7253):83-6. doi: 10.1136/bmj.321.7253.83. |
| 10669200 | Background | Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M. Intranasal midazolam as a treatment of autonomic crisis in patients with familial dysautonomia. Pediatr Neurol. 2000 Jan;22(1):19-22. doi: 10.1016/s0887-8994(99)00109-5. |
| 9746026 | Background | Lahat E, Goldman M, Barr J, Eshel G, Berkovitch M. Intranasal midazolam for childhood seizures. Lancet. 1998 Aug 22;352(9128):620. doi: 10.1016/S0140-6736(05)79574-X. No abstract available. |
| 9435015 | Background | Lahat E. A prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children. Pediatr Emerg Care. 1997 Dec;13(6):449. No abstract available. |
| 11354231 | Background | McGlone R, Smith M. Intranasal midazolam. An alternative in childhood seizures. Emerg Med J. 2001 May;18(3):234. doi: 10.1136/emj.18.3.234. No abstract available. |
| 12410871 | Background | Rainbow J, Browne GJ, Lam LT. Controlling seizures in the prehospital setting: diazepam or midazolam? J Paediatr Child Health. 2002 Dec;38(6):582-6. doi: 10.1046/j.1440-1754.2002.00046.x. |
| 10030327 | Background | Scott RC, Besag FM, Neville BG. Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet. 1999 Feb 20;353(9153):623-6. doi: 10.1016/S0140-6736(98)06425-3. |
| 9014904 | Background | Wallace SJ. Nasal benzodiazepines for management of acute childhood seizures? Lancet. 1997 Jan 25;349(9047):222. doi: 10.1016/S0140-6736(05)64856-8. No abstract available. |
| 1576597 | Background | Wroblewski BA, Joseph AB. The use of intramuscular midazolam for acute seizure cessation or behavioral emergencies in patients with traumatic brain injury. Clin Neuropharmacol. 1992 Feb;15(1):44-9. doi: 10.1097/00002826-199202000-00006. |
| 7806783 | Background | Pellock JM. Status epilepticus in children: update and review. J Child Neurol. 1994 Oct;9 Suppl 2:27-35. |
| 9534684 | Background | Verity CM. Do seizures damage the brain? The epidemiological evidence. Arch Dis Child. 1998 Jan;78(1):78-84. doi: 10.1136/adc.78.1.78. No abstract available. |
| 7619187 | Background | Alldredge BK, Wall DB, Ferriero DM. Effect of prehospital treatment on the outcome of status epilepticus in children. Pediatr Neurol. 1995 Apr;12(3):213-6. doi: 10.1016/0887-8994(95)00044-g. |
| 11994056 | Background | Knoester PD, Jonker DM, Van Der Hoeven RT, Vermeij TA, Edelbroek PM, Brekelmans GJ, de Haan GJ. Pharmacokinetics and pharmacodynamics of midazolam administered as a concentrated intranasal spray. A study in healthy volunteers. Br J Clin Pharmacol. 2002 May;53(5):501-7. doi: 10.1046/j.1365-2125.2002.01588.x. |
| 15123028 | Background | Mahmoudian T, Zadeh MM. Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children. Epilepsy Behav. 2004 Apr;5(2):253-5. doi: 10.1016/j.yebeh.2004.01.003. |
| 11962570 | Background | Vilke GM, Sharieff GQ, Marino A, Gerhart AE, Chan TC. Midazolam for the treatment of out-of-hospital pediatric seizures. Prehosp Emerg Care. 2002 Apr-Jun;6(2):215-7. doi: 10.1080/10903120290938571. |
| 20679166 | Derived | Holsti M, Dudley N, Schunk J, Adelgais K, Greenberg R, Olsen C, Healy A, Firth S, Filloux F. Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Pediatr Adolesc Med. 2010 Aug;164(8):747-53. doi: 10.1001/archpediatrics.2010.130. |
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Age Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Units |
|---|
| Counts |
|---|
| Participants |
|
|
| Secondary | Respiratory Depression Requiring Intubation | Respiratory depression was defined as intubation at Emergency Department discharge. | Analysis was per protocol | Posted | Number | participants | 24 hours |
|
|
|
|
| Secondary | Number of Patients Who Needed Additional Medication to Treat the Seizure in the Emergency Department Within 24 Hours | Posted | Number | participants | 24 hours |
|
|
|
|
| Secondary | Number of Patients Needed to be Seen or Treated in the Emergency Department for Their Seizure and Use of Study Medication. | Posted | Number | participants | 24 hours |
|
|
|
|
| Secondary | Number of Patients That Were Admitted to the Hospital After Their Seizure and Use of Study Medication. | Posted | Number | participants | 24 hours |
|
|
|
|
| Secondary | Number of Patients Who Had a Repeat Seizure Within 12 Hours After Their Seizure Who Used Study Medication | Posted | Number | participants | 12 hours |
|
|
|
|
| Secondary | Respiratory Depression Requiring Oxygen at Discharge From the Emergency Department. | Respiratory depression was defined as requiring oxygen at discharge from the Emergency Department. | Analysis was per protocol | Posted | Number | participants | 24 hours |
|
|
|
|
| 1 |
| 50 |
| 0 |
| 50 |
| EG001 | Rectal Diazepam | 0.3-0.5 Rectal Diazepam for a seizure lasting longer than 5 minutes | 0 | 42 | 0 | 42 |
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| D006571 | Heterocyclic Compounds |
| D001570 | Benzodiazepinones |