Skip to main content
SpringerLink
Log in

Transnasal Revolution? The Promise of Midazolam Spray to Prevent Seizure Clusters

  • Commentary
  • Published:
CNS Drugs Aims and scope Submit manuscript

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Hopkins A, Davies P, Dobson C. Mathematical models of patterns of seizures. Their use in the evaluation of drugs. Arch Neurol. 1985;42(5):463–7.

    Article  CAS  Google Scholar 

  2. Lowenstein DH, Bleck T, Macdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia. 1999;40(1):120–2.

    Article  CAS  Google Scholar 

  3. Sutter R, Dittrich T, Semmlack S, Ruegg S, Marsch S, Kaplan PW. Acute systemic complications of convulsive status epilepticus—a systematic review. Crit Care Med. 2018;46(1):138–45.

    Article  Google Scholar 

  4. Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012;366(7):591–600.

    Article  CAS  Google Scholar 

  5. 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;353(9153):623–6.

    Article  CAS  Google Scholar 

  6. McIntyre J, Robertson S, Norris E, Appleton R, Whitehouse WP, Phillips B, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet. 2005;366(9481):205–10.

    Article  CAS  Google Scholar 

  7. Ashrafi MR, Khosroshahi N, Karimi P, Malamiri RA, Bavarian B, Zarch AV, et al. Efficacy and usability of buccal midazolam in controlling acute prolonged convulsive seizures in children. Eur J Paediatr Neurol. 2010;14(5):434–8.

    Article  Google Scholar 

  8. Rey E, Treluyer JM, Pons G. Pharmacokinetic optimization of benzodiazepine therapy for acute seizures. Focus on delivery routes. Clin Pharmacokinet. 1999;36(6):409–24.

    Article  CAS  Google Scholar 

  9. Sutter R, Tisljar K, Opic P, De Marchis GM, Bassetti S, Bingisser R, et al. Emergency management of status epilepticus in a high-fidelity simulation: a prospective study. Neurology. 2019;93(19):838–48.

    Article  Google Scholar 

  10. Semmlack S, Yeginsoy D, Spiegel R, Tisljar K, Ruegg S, Marsch S, et al. Emergency response to out-of-hospital status epilepticus: a 10-year observational cohort study. Neurology. 2017;89(4):376–84.

    Article  Google Scholar 

  11. Hardmeier M, Zimmermann R, Ruegg S, Pfluger M, Deuster S, Suter K, et al. Intranasal midazolam: pharmacokinetics and pharmacodynamics assessed by quantitative EEG in healthy volunteers. Clin Pharmacol Ther. 2012;91(5):856–62.

    Article  CAS  Google Scholar 

  12. Owusu KA, Dhakar MB, Bautista C, McKimmy D, Cotugno S, Sukumar N, et al. Comparison of intranasal midazolam versus intravenous lorazepam for seizure termination and prevention of seizure clusters in the adult epilepsy monitoring unit. Epilepsy Behav. 2019;98(Pt A):161–7.

    Article  Google Scholar 

  13. Mula M. The safety and tolerability of intranasal midazolam in epilepsy. Expert Rev Neurother. 2014;14(7):735–40.

    Article  CAS  Google Scholar 

  14. 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;321(7253):83–6.

    Article  CAS  Google Scholar 

  15. von Blomberg A, Kay L, Knake S, Fuest S, Z’öllner JP, Reif PS, et al. Efficacy, tolerability, and safety of concentrated intranasal midazolam spray as emergency medication in epilepsy patients during video-EEG monitoring. CNS Drugs. 2020. https://doi.org/10.1007/s40263-020-00720-w.

    Article  Google Scholar 

  16. Kay L, Merkel N, von Blomberg A, Willems LM, Bauer S, Reif PS, et al. Intranasal midazolam as first-line inhospital treatment for status epilepticus: a pharmaco-EEG cohort study. Ann Clin Transl Neurol. 2019;6(12):2413–25.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Intensive Care Units and Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Raoul Sutter

  2. Medical Faculty, University of Basel, Basel, Switzerland

    Raoul Sutter

  3. Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA

    Peter W. Kaplan

Authors
  1. Raoul Sutter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter W. Kaplan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raoul Sutter.

Ethics declarations

Funding

No funding was received for publication of this commentary.

Conflict of interest

Dr. Raoul Sutter received research grants from the Swiss National Foundation (No 320030_169379), the Research Fund of the University Basel, the Scientific Society Basel, and the Gottfried Julia Bangerter-Rhyner Foundation. He received personal grants from UCB-pharma and holds stocks from Alcon, Novartis, Roche, and Johnson & Johnson. Dr. Peter W. Kaplan has provided unsponsored grand rounds and published books on EEG, status epilepticus, and epilepsy, for which he received honoraria, and is on the Qatar Research Foundation grant on continuous EEG monitoring in status epilepticus.

Additional information

This commentary comments on the article available at https://doi.org/10.1007/s40263-020-00720-w.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sutter, R., Kaplan, P.W. Transnasal Revolution? The Promise of Midazolam Spray to Prevent Seizure Clusters. CNS Drugs 34, 555–557 (2020). https://doi.org/10.1007/s40263-020-00724-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40263-020-00724-6

Search

Navigation