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Randomized Controlled Trial
. 2017 Jul;31(4):1149-1158.
doi: 10.1111/jvim.14734. Epub 2017 May 24.

Intranasal Midazolam versus Rectal Diazepam for the Management of Canine Status Epilepticus: A Multicenter Randomized Parallel-Group Clinical Trial

M Charalambous  1   2 , S F M Bhatti  1 , L Van Ham  1 , S Platt  3 , N D Jeffery  4 , A Tipold  5 , J Siedenburg  6 , H A Volk  7 , D Hasegawa  8 , A Gallucci  9 , G Gandini  9 , M Musteata  10 , E Ives  2   11 , A E Vanhaesebrouck  2
Affiliations
Randomized Controlled Trial

Intranasal Midazolam versus Rectal Diazepam for the Management of Canine Status Epilepticus: A Multicenter Randomized Parallel-Group Clinical Trial

M Charalambous et al. J Vet Intern Med. 2017 Jul.

Abstract

Background: Intranasal administration of benzodiazepines has shown superiority over rectal administration for terminating emergency epileptic seizures in human trials. No such clinical trials have been performed in dogs.

Objective: To evaluate the clinical efficacy of intranasal midazolam (IN-MDZ), via a mucosal atomization device, as a first-line management option for canine status epilepticus and compare it to rectal administration of diazepam (R-DZP) for controlling status epilepticus before intravenous access is available.

Animals: Client-owned dogs with idiopathic or structural epilepsy manifesting status epilepticus within a hospital environment were used. Dogs were randomly allocated to treatment with IN-MDZ (n = 20) or R-DZP (n = 15).

Methods: Randomized parallel-group clinical trial. Seizure cessation time and adverse effects were recorded. For each dog, treatment was considered successful if the seizure ceased within 5 minutes and did not recur within 10 minutes after administration. The 95% confidence interval was used to detect the true population of dogs that were successfully treated. The Fisher's 2-tailed exact test was used to compare the 2 groups, and the results were considered statistically significant if P < .05.

Results: IN-MDZ and R-DZP terminated status epilepticus in 70% (14/20) and 20% (3/15) of cases, respectively (P = .0059). All dogs showed sedation and ataxia.

Conclusions and clinical importance: IN-MDZ is a quick, safe and effective first-line medication for controlling status epilepticus in dogs and appears superior to R-DZP. IN-MDZ might be a valuable treatment option when intravenous access is not available and for treatment of status epilepticus in dogs at home.

Keywords: Benzodiazepine; Dog; Emergency; Epileptic seizures.

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Figures

Figure 1
Figure 1
Mucosal administration device (MAD). The device consists of a syringe (1 mL or 3 mL) and the, attached to the syringe, atomizer. The latter turns the medication into a fine mist (30–100 μm).
Figure 2
Figure 2
Flowchart presenting a summary of the protocol.
See this image and copyright information in PMC

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