Pediatric Neurology
Volume 33, Issue 3 , Pages 166-172 , September 2005

Rectal Diazepam Gel in the Home Management of Seizures in Children

Presented in part at the American Epilepsy Society Annual Meetings, Los Angeles, California, December 1–6, 2000 and Boston, Massachusetts, December 5–10, 2003; and at Child Neurology Society Meeting, Ottawa, Canada, October 13–16, 2004.

  • Christine O’Dell, RN, MSN

      Affiliations

    • Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
    • Department of Nursing, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
    • Department of Comprehensive Epilepsy Management Center, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
    • Corresponding Author InformationCommunications should be addressed to: Ms. O’Dell; Clinical Nurse Specialist, Epilepsy; Comprehensive Epilepsy Management Center; Montefiore Medical Center; 111 East 210th Street; Bronx, New York 10467.
  • ,
  • Shlomo Shinnar, MD, PhD

      Affiliations

    • Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
    • Department of Comprehensive Epilepsy Management Center, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
    • Department of Pediatrics, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
  • ,
  • Karen R. Ballaban-Gil, MD

      Affiliations

    • Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
    • Department of Comprehensive Epilepsy Management Center, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
    • Department of Pediatrics, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
  • ,
  • Matthew Hornick

      Affiliations

    • Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
  • ,
  • Maryana Sigalova, MA

      Affiliations

    • Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
  • ,
  • Harriet Kang, MD

      Affiliations

    • Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
    • Department of Comprehensive Epilepsy Management Center, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
    • Department of Pediatrics, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
  • ,
  • Solomon L. Moshé, MD

      Affiliations

    • Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
    • Department of Comprehensive Epilepsy Management Center, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
    • Department of Pediatrics, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
    • Department of Neuroscience, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York

Received 16 December 2004 ,Accepted 14 March 2005.

References 

  1. Kriel RL , Cloyd JC , Hadsall RS , Carlson AM , Floren KL , Jones-Saete CM . Home use of rectal diazepam for cluster and prolonged seizures (Efficacy, adverse reactions, quality of life, and cost analysis) . Pediatr Neurol . 1991;7:13–17
  2. Hightower S , Carmon M , Minick P . A qualitative descriptive study of the lived experiences of school-aged children with epilepsy . J Pediatr Health Care . 2002;16:131–137
  3. Dodson WE , DeLorenzo RJ , Pedley TA , Shinnar S , Treiman DM , Wannamaker BB . The treatment of convulsive status epilepticus (Recommendations of the Epilepsy Foundation of America’s working group on status epilepticus) . JAMA . 1993;270:854–859
  4. Lowenstein DH , Bleck T , Macdonald RL . It’s time to revise the definition of status epilepticus . Epilepsia . 1999;40:120–122
  5. Alldredge BK , Gelb AM , Isaacs SM , et al.   A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus . N Engl J Med . 2001;345:631–637
  6. Dreifuss FE , Rosman NP , Cloyd JC , et al.   A comparison of rectal diazepam gel and placebo for acute repetitive seizures . N Engl J Med . 1998;338:1869–1875
  7. Cereghino JJ , Mitchell WG , Murphy J , Kriel RL , Rosenfeld WE , Trevathan E  The North American Diastat Study Group . Treating repetitive seizures with a rectal diazepam formulation (A randomized study) . Neurology . 1998;51:1274–1282
  8. Mitchell WG , Conry JA , Crumrine PK , et al.  North American Diastat Study Group   An open-label study of repeated use of diazepam rectal gel (Diastat) for episodes of acute breakthrough seizures and clusters (Safety, efficacy, and tolerance) . Epilepsia . 1999;40:1610–1617
  9. Cereghino JJ , Cloyd JC , Kusniecky RI . Rectal diazepam gel for treatment of acute repetitive seizures in adults . Arch Neurol . 2002;59:1915–1920
  10. Commission on Epidemiology and Prognosis, International League Against Epilepsy . Guidelines for epidemiologic studies on epilepsy . Epilepsia . 1993;34:592–596
  11. Commission on Classification and Terminology of the International League Against Epilepsy . Proposal for revised classification of epilepsies and epileptic syndromes . Epilepsia . 1989;30:389–399
  12. Commission on Classification and Terminology of the International League Against Epilepsy . Proposal for revised clinical and electroencephalographic classification of epileptic seizures . Epilepsia . 1981;22:489–501
  13. Carpay JA , Vermeulen J , Stroink H , et al.   Seizure severity in children with epilepsy (A parent-completed scale compared with clinical data) . Epilepsia . 1997;38:346–352
  14. Lukacz ES , Lawrence JM , Burchette RJ , Luber KM , Nager CW , Buckwalter JG . The use of visual analog scale in urogynecologic research (A psychometric evaluation) . Am J Obstet Gynecol . 2004;19:165–170
  15. Gallagher EG , Bijur PE , Latimer C , Silver W . Reliability and validity of a visual analog scale for acute abdominal pain in the ED . Am J Emerg Med . 2002;20:287–290
  16. Gift AG . Visual analog scales (Measurement of subjective phenomenon) . Nursing Res . 1989;38:286–288
  17. Kelsey JL , Thompson WD , Evans AS . Methods in observational epidemiology . New York: Oxford University Press; 1986;
  18. Zar JH . In: Biostatistical analysis . 2nd ed. Englewood Cliffs, NJ: Prentice Hall; 1984;p. 1–121
  19. SAS Institute Inc. . SAS user’s guide statistics . 1985 ed. Cary, NC: SAS Institute Inc; 1985;
  20. Baumer JH , David TJ , Valentine SJ , Roberts JE , Hughes BR . Many parents think their child is dying when having a first febrile convulsion . Dev Med Child Neurol . 1981;23:462–464
  21. O’Dell C . What do we tell parents of a child with simple or complex febrile seizures . In:  Baram TZ ,  Shinnar S editor. Febrile seizures . San Diego: Academic Press; 2002;p. 305–316
  22. Shinnar S , Berg AT , Moshe SL , Shinnar R . How long do new-onset seizures in children last? . Ann Neurol . 2001;49:659–664
  23. Berg AT , Shinnar S . Complex febrile seizures . Epilepsia . 1996;37:126–133
  24. Corey LA , Pellock JM , Boggs JG , Miller LL , DeLorenzo RJ . Evidence for a genetic predisposition for status epilepticus . Neurology . 1998;50:558–560
  25. Sillanpaa M , Shinnar S . Status epilepticus in a population-based cohort with childhood-onset epilepsy in Finland . Ann Neurol . 2002;52:303–310
  26. Berg AT , Shinnar S , Testa FM , et al.   Status epilepticus after the initial diagnosis of epilepsy in children . Neurol . 2004;63:1027–1034
  27. Maytal J , Shinnar S , Moshe SL , Alvarez LA . Low morbidity and mortality of status epilepticus in children . Pediatrics . 1989;83:323–331
  28. Shinnar S , Pellock JM , Moshe SL , et al.   In whom does status epilepticus occur (Age-related differences in children) . Epilepsia . 1997;38:907–914
  29. Dieckmann RA . Rectal diazepam for prehospital pediatric status epilepticus . Ann Emerg Med . 1995;23:216–224
  30. Pellock JM , Shinnar S . Respiratory adverse events associated with diazepam rectal gel Neurology . 2005; In press
  31. Smeltzer CH , Curtis L . Analyzing patient time in the emergency department . Qual Rev Bull . 1986;12:380–382
  32. Terris J , Leman P , O’Connor N , Wood R . Making an IMPACT on emergency department flow (Improving patient processing assisted by consultant at triage) . Emerg Med J . 2004;21:537–541

PII: S0887-8994(05)00167-0

doi: 10.1016/j.pediatrneurol.2005.03.005

Pediatric Neurology
Volume 33, Issue 3 , Pages 166-172 , September 2005