Adult patient perceptions of emergency rectal medications for refractory seizures

Abstract

Background. Rectally administered benzodiazepine antiepilepsy drugs (AEDs) are a safe and effective therapy for acute repetitive seizures in patients on stable maintenance AEDs. Such medication provides an earlier treatment option for seizure control prior to emergency department (ED) visitation and may be administered outside of the hospital in carefully selected patients. The use of rectal medications, however, has a perceived association with fear and embarrassment. This study sought to address patient attitudes toward rectally delivered AEDs. Methods. A written, eight-question survey regarding adult patient attitudes toward rectal medication and ED visits was prospectively administered to 91 consecutive epilepsy patients in an epilepsy-based practice setting. Primary caretakers responded when patients were unable to do so. RESULTS: Forty-eight female and thirty-two male survey responses were analyzed. The mean patient population was age 42.7 years with epilepsy for 23.7 years on 1.7 AEDs with a seizure frequency of 6.6/month. The majority had partial and generalized tonic-clonic seizures and had obtained at least a high school education. Three patients (6%) had symptomatic generalized epilepsy and required caretaker responses. Eleven of ninety-one (12.1%) surveys were incomplete for analysis. Seventy-six of eighty (95%) respondents completed at least 50% of the survey questions. Forty-three of sixty-four (67.2%) respondents were not embarrassed by rectal AEDs, and did not fear being teased by others. Additionally, most felt rectal AEDs were a good option in epilepsy management, yet would prefer a private setting for administration. Both seizures and rectal AED use appeared to be equally embarrassing to patients. While 53 of 76 (69.7%) reported ED visitation for seizures at some time, the vast majority (56/60, 93.3%) reported they would prefer treatment outside the hospital, as opposed to ED transport. Conclusions. The results from this adult patient survey suggest that individuals with epilepsy do not object to earlier administration of emergency rectal seizure medication relative to ED visitation. An undesirable perception of rectal medications in seizure emergencies does not appear to be limited by patient acceptance.