Intranasal Therapy to Stop Status Epilepticus in Prehospital Settings
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Intranasal Therapy to Stop Status Epilepticus in Prehospital Settings John Benfield1 • Alberto Musto1
Ó The Author(s) 2017. This article is an open access publication
Abstract Status epilepticus (SE) is a medical emergency characterized by uncontrolled, prolonged seizures with rapid and widespread neuronal damage. Patients that suffer from longer episodes of SE are more likely to have poorer clinical outcomes and a higher cost of healthcare. Understanding novel molecular mechanisms that regulate inhibitory and excitatory neurotransmission that initiate SE and the necessary medical infrastructure to stop SE could help identify targets for early intervention. Intranasal administration of benzodiazepines may shorten the time between initiation and cessation of seizures when compared to other routes of administration. Current pharmaceutical administration guidelines are appropriate for sporadic incidences of SE, but exploring other approaches is necessary to prepare for situations involving multiple patients outside of a hospital, such as a massive chemical weapons attack. Intranasal drug delivery helps to circumvent the blood– brain barrier and offers a noninvasive way to quickly administer drugs in settings that require an immediate response, such as nerve agent exposure. In addition, examining the intranasal delivery of new drugs, such as nanotherapeutics, may lead to more effective, noninvasive, scalable, and portable methods of treating SE.
& Alberto Musto [email protected] 1
Department of Pathology, Anatomy, and Neurology, Eastern Virginia Medical School, Norfolk, VA, USA
Key Points: Status epilepticus (SE) requires immediate therapeutic intervention. Intranasal delivery methods are under-utilized as a potential therapy. Current work is being done to facilitate treatment of SE with intranasal therapeutics.
1 Introduction Status epilepticus (SE) is a medical emergency in which a patient has an abnormally prolonged seizure (greater than 30 min) or multiple prolonged seizures without an intervening restoration of consciousness or physiological neurological function. The Commission on Classification and Terminology and the Commission on Epidemiology of the International League Against Epilepsy (ILAE) have recently published a definition of SE as follows [1]: ‘‘SE is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms which lead to abnormally prolonged seizures. It is a condition, which can have long-term consequences, including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures.’’ A longer time frame between the onset of SE and initial medical treatment is associated with a higher rate of mortality and a poorer neurological functional outcome as
J. Benfield, A. Musto
measured by the Modified Rankin Scale, which is a measure of independence and disability [2]. It has been shown that the length of the seizure is directly correlated to the degree o
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