NeuroBites May 30th, 2018 – Intranasal Midazolam for Epilepticus Management


Every week, the BVNS neurologists, residents and interns convene to discuss a human or veterinary neurology/neurosurgery article.

NeuroBites is a digestible synopsis written by Dr. Bush of the article covered in journal club.

Welcome to NeuroBites.

Charalambous M, et al. Intranasal Midazolam versus Rectal Diazepam for the Management of Canine Status Epilepticus: A Multicenter Randomized Parallel-Group Clinical Trial.
J Vet Intern Med 2017;31:1149–1158.

Click HERE for the full article.

Pick the correct answer below with regard to the definition of MAD.

1) Angry, i.e. Aiden was mad when William kicked him
2) Very, i.e. James has mad computer skills
3) Insane, i.e. The incessant high pitched bark from the Chihuahua who was driving the cat in the next cage mad
4) Mucosal administration device, i.e. Wednesday’s journal club featured the use of a MAD which is pictured below
5) All of the above








This Wednesday, Dr. Stallings did a very nice job with journal club, where she described the use of a MAD to deliver a seizure medication called midazolam to the nose (nasal mucosa) to stop status epilepticus.

This was particularly timely as Dr. Bensfield has spearheaded an effort for every BVNS clinic to dispense midazolam and a MAD to patients at risk for status epilepticus. When BVNS adopts this innovative device we are hopeful to save lives.

What is status epilepticus?
The state of continual seizure defined as having a seizure when arriving to the hospital, a seizure lasting more than 5 minutes or having 2 seizures without a return to being normal.

Is status epilepticus common?
Yup. About 20-60 % of dogs with repeated seizure of unknown origin will experience at least 1 episode in their lifetime.

Is status epilepticus bad?
Yup. Between 25 to 39% of dogs will die from status epilepticus.

What did Dr. Stalling’s journal club reveal?
70% of dogs getting midazolam with a MAD had control of their status epilepticus compared to only 20% with rectal valium.

Where is the opportunity for innovation?
The longer the seizure the more likely a patient will die. Therefore, successful at home treatment will save lives. As mentioned above, BVNS will start dispensing the MAD and midazolam to selected seizure patients with the hopes that successful at home treatment can save their lives.

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