Abstract：
Limited acute home treatments are available for patients with prolonged (>5 minutes) or repetitive (≥2 in 24 hours) seizures. While this early seizure treatment may reduce the need for emergency care, intermittent intranasal benzodiazepine formulations are expensive and rectal diazepam administration is often socially unacceptable. We determined whether caregivers could use sublingual lorazepam oral concentrate solution effectively as acute treatment for adults with prolonged and repetitive seizures.
Patients prescribed sublingual lorazepam solution at the Johns Hopkins Epilepsy Center for acute seizure treatment during a 5-year period (2012-2017) were screened. We determined clinical history of seizure patterns and number of antiseizure medications (ASMs) through patient and caregiver surveys, and we verified this history in patients\' medical records and charts. During a 2-year span (2017-2018), patients and caregivers were surveyed on responses to their most recent use of sublingual lorazepam solution, including seizure cessation (prolonged seizure stopping <5 minutes or ≤1 repetitive seizure), presence of sedation and adverse events within 24 hours of administration, and whether refrigeration limited use.
In total, 52 patients used sublingual lorazepam for treatment of acute seizures during the study period (median dose 1 mg, range 0.5 to 2 mg). Of them, 48 patients participated in treatment survey interviews. Family caregivers usually administered lorazepam (88%); 3 self-administered. Patients were surveyed on responses to their most recent use of sublingual lorazepam treatment: 66% (23/35) of patients with repetitive seizures reported no further seizure activity after administering treatment; 70% (7/10) with prolonged seizures reported seizure activity ceased within 5 minutes of treatment. Three patients treated auras and had no seizures. There were no serious adverse events during most recent use: 31% of patients developed moderate/severe sedation. Of note, 98% refrigerated lorazepam, often with coolers; 44%, however, said this limited treatment access. There was high treatment satisfaction; 79% reported that having the emergency treatment available made them feel safer.
This patient survey and retrospective chart review demonstrates that home treatment with sublingual lorazepam solution may be effective for interrupting prolonged and repetitive seizures. No patients had sedation complications with home doses of 0.5 to 2 mg, and patients report high satisfaction with the treatment.
Patients prescribed sublingual lorazepam solution at the Johns Hopkins Epilepsy Center for acute seizure treatment during a 5-year period (2012-2017) were screened. We determined clinical history of seizure patterns and number of antiseizure medications (ASMs) through patient and caregiver surveys, and we verified this history in patients\' medical records and charts. During a 2-year span (2017-2018), patients and caregivers were surveyed on responses to their most recent use of sublingual lorazepam solution, including seizure cessation (prolonged seizure stopping <5 minutes or ≤1 repetitive seizure), presence of sedation and adverse events within 24 hours of administration, and whether refrigeration limited use.
In total, 52 patients used sublingual lorazepam for treatment of acute seizures during the study period (median dose 1 mg, range 0.5 to 2 mg). Of them, 48 patients participated in treatment survey interviews. Family caregivers usually administered lorazepam (88%); 3 self-administered. Patients were surveyed on responses to their most recent use of sublingual lorazepam treatment: 66% (23/35) of patients with repetitive seizures reported no further seizure activity after administering treatment; 70% (7/10) with prolonged seizures reported seizure activity ceased within 5 minutes of treatment. Three patients treated auras and had no seizures. There were no serious adverse events during most recent use: 31% of patients developed moderate/severe sedation. Of note, 98% refrigerated lorazepam, often with coolers; 44%, however, said this limited treatment access. There was high treatment satisfaction; 79% reported that having the emergency treatment available made them feel safer.
This patient survey and retrospective chart review demonstrates that home treatment with sublingual lorazepam solution may be effective for interrupting prolonged and repetitive seizures. No patients had sedation complications with home doses of 0.5 to 2 mg, and patients report high satisfaction with the treatment.
摘要：
目的：对于长期（>5分钟）或反复（24小时内≥2次）癫痫发作的患者，可进行有限的急性家庭治疗。虽然这种早期癫痫治疗可能会减少急诊护理的需要，间歇性鼻内苯二氮卓制剂价格昂贵，直肠给药地西泮通常是社会不可接受的。我们确定护理人员是否可以使用舌下劳拉西泮口服浓缩溶液有效地作为成人长期和重复性癫痫发作的急性治疗。
方法：在约翰霍普金斯大学癫痫中心（JohnsHopkinsEgriepsy）5年期间（2012-2017年）使用舌下含服劳拉西泮治疗的患者进行筛查。我们通过患者和护理人员调查确定了癫痫发作模式的临床病史和抗癫痫药物（ASM）的数量，我们在病人的医疗记录和图表中证实了这一病史.在两年的时间里(2017-2018年)，调查了患者和护理人员对他们最近使用舌下使用劳拉西泮溶液的反应，包括癫痫发作停止（长时间癫痫发作停止<5分钟或≤1次反复发作），在给药后24小时内出现镇静和不良事件，以及制冷是否有限使用。
结果：总计，52例患者在研究期间使用舌下劳拉西泮治疗急性癫痫发作（中位剂量1mg，范围为0.5至2毫克)。其中,48例患者参加治疗调查访谈。家庭护理人员通常服用劳拉西泮（88％）；3自我给药。对患者最近使用舌下劳拉西泮治疗的反应进行了调查：66％（23/35）的重复性癫痫发作患者在给予治疗后没有进一步的癫痫发作活动；70％（7/10）的长期癫痫发作报告癫痫发作活动在治疗后5分钟内停止。三名患者治疗了光环，没有癫痫发作。在最近一次使用期间没有严重的不良事件：31％的患者出现中度/重度镇静。值得注意的是，98%冷藏劳拉西泮,通常带有冷却器；44%，然而,说这有限的治疗途径。治疗满意度很高；79％的人报告说，获得紧急治疗使他们感到更安全。
结论：这项患者调查和回顾性图表审查表明，舌下劳拉西泮溶液家庭治疗可有效中断长期和重复性癫痫发作。家庭剂量为0.5至2mg时，没有患者出现镇静并发症，患者报告对治疗的满意度很高。
方法：在约翰霍普金斯大学癫痫中心（JohnsHopkinsEgriepsy）5年期间（2012-2017年）使用舌下含服劳拉西泮治疗的患者进行筛查。我们通过患者和护理人员调查确定了癫痫发作模式的临床病史和抗癫痫药物（ASM）的数量，我们在病人的医疗记录和图表中证实了这一病史.在两年的时间里(2017-2018年)，调查了患者和护理人员对他们最近使用舌下使用劳拉西泮溶液的反应，包括癫痫发作停止（长时间癫痫发作停止<5分钟或≤1次反复发作），在给药后24小时内出现镇静和不良事件，以及制冷是否有限使用。
结果：总计，52例患者在研究期间使用舌下劳拉西泮治疗急性癫痫发作（中位剂量1mg，范围为0.5至2毫克)。其中,48例患者参加治疗调查访谈。家庭护理人员通常服用劳拉西泮（88％）；3自我给药。对患者最近使用舌下劳拉西泮治疗的反应进行了调查：66％（23/35）的重复性癫痫发作患者在给予治疗后没有进一步的癫痫发作活动；70％（7/10）的长期癫痫发作报告癫痫发作活动在治疗后5分钟内停止。三名患者治疗了光环，没有癫痫发作。在最近一次使用期间没有严重的不良事件：31％的患者出现中度/重度镇静。值得注意的是，98%冷藏劳拉西泮,通常带有冷却器；44%，然而,说这有限的治疗途径。治疗满意度很高；79％的人报告说，获得紧急治疗使他们感到更安全。
结论：这项患者调查和回顾性图表审查表明，舌下劳拉西泮溶液家庭治疗可有效中断长期和重复性癫痫发作。家庭剂量为0.5至2mg时，没有患者出现镇静并发症，患者报告对治疗的满意度很高。
