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Intranasal seizure

Samia A Nour, Nevine S Abdelmalak, Marianne J Naguib, Hassan M Rashed, Ahmed B Ibrahim
Clonazepam (CZ) is an anti-epileptic drug used mainly in status epilepticus (SE). The drug belongs to Class II according to BCS classification with very limited solubility and high permeability and it suffers from extensive first-pass metabolism. The aim of the present study was to develop CZ-loaded polymeric micelles (PM) for direct brain delivery allowing immediate control of SE. PM were prepared via thin film hydration (TFH) technique adopting a central composite face-centered design (CCFD). The seventeen developed formulae were evaluated in terms of entrapment efficiency (EE), particle size (PS), polydispersity index (PDI), zeta potential (ZP), and in vitro release...
September 20, 2016: Drug Delivery
Debbie Terry, Anup D Patel, Daniel M Cohen, Daniel Scherzer, Jennifer Kline
The purpose of this study was to assess school nurses' perceptions of barriers to optimal management of seizures in schools. Eighty-three school nurses completed an electronic survey. Most agreed they felt confident they could identify a seizure (97.6%), give rectal diazepam (83.8%), and handle cluster seizures (67.1%), but fewer were confident they could give intranasal midazolam (63.3%), had specific information about a student's seizures (56.6%), or could swipe a vagus nerve stimulator magnet (47.4%). Nurses were more likely to be available at the time of a seizure in rural (17/20) (85%) versus suburban (21/34) (62%) or urban (8/25) (32%) schools (P = ...
September 12, 2016: Journal of Child Neurology
Sheryl R Haut, Syndi Seinfeld, John Pellock
PURPOSE: The aim of this review was to systematically examine safety and efficacy outcomes, as well as patient/caregiver satisfaction, from clinical studies in pediatric and adult patients treated with benzodiazepines (BZDs) through various administration routes in response to seizure emergencies. METHODS: A literature search was conducted to identify articles describing the use of various routes of administration (RoAs) of BZDs for the treatment of seizure emergencies through April 21, 2015, using Embase™ and PubMed®...
October 2016: Epilepsy & Behavior: E&B
Daniel Crawford
Currently, evidence supports the use of intranasal midazolam as an effective, and in many cases, preferable treatment option for prolonged seizures in children. Despite this knowledge, intranasal midazolam is not routinely found as a standard of care. The goal of this project was to implement the use of intranasal midazolam as a rescue medication for prolonged seizures within a child neurology practice and, in doing so, create a model for implementation that would be replicable for other practice sites. This project focused on the development of a process to make intranasal midazolam available as a treatment option and then the creation of an educational intervention for providers within a child neurology practice...
September 5, 2016: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Sandeep Patri, Yashwant Agrawal, Susan F Bannon
No abstract text is available yet for this article.
August 17, 2016: American Journal of Therapeutics
Michal Zelcer, Ran D Goldman
QUESTION: There are times when parents arrive to my clinic after their child has had a seizure and a second seizure takes place in the clinic. While waiting for transport to the hospital, are there ways to stop the seizures without the need to obtain intravenous access in the clinic? ANSWER: Intravenous diazepam has been a first-line therapy to stop seizures in children for many years. Other routes of drug administration such as intramuscular, rectal, and buccal are available but have several limitations...
July 2016: Canadian Family Physician Médecin de Famille Canadien
Mamta Kapoor, James C Cloyd, Ronald A Siegel
Epileptic seizure emergencies are life-threatening conditions, which in their most severe form, status epilepticus, have a high mortality rate if not quickly terminated. Treatment requires rapid delivery of anti-epileptics such as benzodiazepines to the brain. The nasal route is attractive due to its non-invasiveness, potential for direct nose to brain delivery, high vascularity, relatively large absorptive surface area, and avoidance of intestinal/liver metabolism. However, the limited volume of the nasal cavity and poor water solubility of anti-epileptics restrict absorption, leading to insufficient therapeutic brain levels...
September 10, 2016: Journal of Controlled Release: Official Journal of the Controlled Release Society
Elizabeth Nicholas, Matthew D Thornton
BACKGROUND: Epistaxis is a common problem that occurs in up to 60% of the general population, and is a common emergency department (ED) complaint. The use of lidocaine for analgesia is common when cauterization is required for bleeds that are refractory to manual compression. Although the use of lidocaine is generally thought of as a benign intervention, it is not completely without risk. CASE REPORT: We present the case of a 19-year-old man who presented to the ED with persistent anterior epistaxis...
September 2016: Journal of Emergency Medicine
Mamta Kapoor, Narsihmulu Cheryala, Davin Rautiola, Gunda I Georg, James C Cloyd, Ronald A Siegel
Water-soluble prodrugs can be rapidly converted by enzymes to hydrophobic drugs, whose aqueous thermodynamic solubilities are low, but are maintained in aqueous solution at supersaturated concentrations due to slow precipitation kinetics. Recently, we investigated avizafone (AVF) in combination with Aspergillus oryzae protease as a prodrug/enzyme system intended to produce supersaturated diazepam (DZP). Several fold enhancement of permeation of supersaturated DZP across Madin-Darby canine kidney II-wild type (MDCKII-wt) monolayers was observed, compared to saturated DZP solutions...
August 2016: Journal of Pharmaceutical Sciences
Nayomi Shermila Jayasinghe, Eranga Thalagala, Milanka Wattegama, Kanapathipillai Thirumavalavan
BACKGROUND: Neurological manifestations in dengue fever occur in <1 % of the patients and known to be due to multisystem dysfunction secondary to vascular leakage. Occurrence of wide spread cerebral haemorrhages with subdural hematoma during the leakage phase without profound thrombocytopenia and occurrence of cranial diabetes insipidus are extremely rare and had not been reported in published literature earlier, thus we report the first case. CASE PRESENTATION: A 24 year old previously healthy lady was admitted on third day of fever with thrombocytopenia...
2016: BMC Research Notes
Soon-Tae Lee, Daejong Jeon, Kon Chu, Keun-Hwa Jung, Jangsup Moon, Junsang Sunwoo, Dong-Kyu Park, Hyunwoo Yang, Ji-Hyun Park, Manho Kim, Jae-Kyu Roh, Sang Kun Lee
Inhibitory synaptic receptors are dysfunctional in epileptic brains, and agents that selectively target these receptors may be effective for the treatment of epilepsy. MicroRNAs interfere with the translation of target genes, including various synaptic proteins. Here, we show that miR-203 regulates glycine receptor-β (Glrb) in epilepsy models. miR-203 is upregulated in the hippocampus of epileptic mice and human epileptic brains and is predicted to target inhibitory synaptic receptors, including Glrb. In vitro transfection, target gene luciferase assays, and analysis of human samples confirmed the direct inhibition of GLRB by miR-203, and AM203, an antagomir targeting miR-203, reversed the effect of miR-203...
May 10, 2016: Molecular Neurobiology
Mounira Sabilallah, Pierre Fontanaud, Nathalie Linck, Badreddine Boussadia, Ronan Peyroutou, Thibault Lasgouzes, François A Rassendren, Nicola Marchi, Helene E Hirbec
Kainic acid (KA) is routinely used to elicit status epilepticus (SE) and epileptogenesis. Among the available KA administration protocols, intranasal instillation (IN) remains understudied. Dosages of KA were instilled IN in mice. Racine Scale and Video-EEG were used to assess and quantify SE onset. Time spent in SE and spike activity was quantified for each animal and confirmed by power spectrum analysis. Immunohistochemistry and qPCR were performed to define brain inflammation occurring after SE, including activated microglial phenotypes...
2016: PloS One
Puneet Jain, Suvasini Sharma, Tarun Dua, Corrado Barbui, Rashmi Ranjan Das, Satinder Aneja
OBJECTIVES: To explore the existing evidence for anti-convulsant drugs and their routes of administration in treating acute seizures in children and adults when intravenous access is not available. METHODS: All major databases including Medline via Ovid, PubMed, Cochrane CENTRAL, Embase, and Google Scholar were searched till May 2015. Randomized and quasi-randomized controlled trials comparing two anti-convulsant drugs (at least one comparator being administered through non-intravenous route) for treatment of acute seizures were included...
May 2016: Epilepsy Research
Tracy Glauser, Shlomo Shinnar, David Gloss, Brian Alldredge, Ravindra Arya, Jacquelyn Bainbridge, Mary Bare, Thomas Bleck, W Edwin Dodson, Lisa Garrity, Andy Jagoda, Daniel Lowenstein, John Pellock, James Riviello, Edward Sloan, David M Treiman
CONTEXT: The optimal pharmacologic treatment for early convulsive status epilepticus is unclear. OBJECTIVE: To analyze efficacy, tolerability and safety data for anticonvulsant treatment of children and adults with convulsive status epilepticus and use this analysis to develop an evidence-based treatment algorithm. DATA SOURCES: Structured literature review using MEDLINE, Embase, Current Contents, and Cochrane library supplemented with article reference lists...
January 2016: Epilepsy Currents
Eugen Trinka, Francesco Brigo, Simon Shorvon
PURPOSE OF REVIEW: This review discusses advances in the understanding of the mechanisms of status epilepticus and its current treatment approaches. Many of these have been topics at the 5th London-Innsbruck Colloquium on status epilepticus 2015. RECENT FINDINGS: A new definition and classification of status epilepticus was proposed, which is expected to improve treatment and stimulate research. A better understanding of the failure of seizure suppressing mechanisms and the initiation of self-sustaining seizures begins to translate into the clinical arena...
April 2016: Current Opinion in Neurology
Toshio Munesue, Hiroyuki Nakamura, Mitsuru Kikuchi, Yui Miura, Noriyuki Takeuchi, Tokie Anme, Eiji Nanba, Kaori Adachi, Kiyotaka Tsubouchi, Yoshimichi Sai, Ken-Ichi Miyamoto, Shin-Ichi Horike, Shigeru Yokoyama, Hideo Nakatani, Yo Niida, Hirotaka Kosaka, Yoshio Minabe, Haruhiro Higashida
UNLABELLED: Approximately half of autism spectrum disorder (ASD) individuals suffer from comorbid intellectual disabilities (IDs). Oxytocin (OXT) receptors are highly expressed in temporal lobe structures and are likely to play a modulatory role in excitatory/inhibitory balance, at least based on animal model findings. Thus, it is feasible that in the highly representative group of Kanner-type ASD subjects, OXT could have a beneficial effect on social communication and social interaction...
2016: Frontiers in Psychiatry
Michael R Rickels, Katrina J Ruedy, Nicole C Foster, Claude A Piché, Hélène Dulude, Jennifer L Sherr, William V Tamborlane, Kathleen E Bethin, Linda A DiMeglio, R Paul Wadwa, Andrew J Ahmann, Michael J Haller, Brandon M Nathan, Santica M Marcovina, Emmanouil Rampakakis, Linyan Meng, Roy W Beck
OBJECTIVE: Treatment of severe hypoglycemia with loss of consciousness or seizure outside of the hospital setting is presently limited to intramuscular glucagon requiring reconstitution immediately prior to injection, a process prone to error or omission. A needle-free intranasal glucagon preparation was compared with intramuscular glucagon for treatment of insulin-induced hypoglycemia. RESEARCH DESIGN AND METHODS: At eight clinical centers, a randomized crossover noninferiority trial was conducted involving 75 adults with type 1 diabetes (mean age, 33 ± 12 years; median diabetes duration, 18 years) to compare intranasal (3 mg) versus intramuscular (1 mg) glucagon for treatment of hypoglycemia induced by intravenous insulin...
February 2016: Diabetes Care
Ravindra Arya, Harsh Kothari, Zongjun Zhang, Baoguang Han, Paul S Horn, Tracy A Glauser
OBJECTIVE: This is a network meta-analysis of nonvenous drugs used in randomized controlled trials (RCTs) for treatment of acute convulsive seizures and convulsive status epilepticus. METHODS: Literature was searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for RCTs examining treatment of acute convulsive seizures or status epilepticus with at least one of the study arms being a nonvenous medication. After demographic and outcome data extraction, a Bayesian network meta-analysis was performed and efficacy results were summarized using treatment effects and their credible intervals (CrI)...
November 24, 2015: Neurology
Johan A F Koekkoek, Tjeerd J Postma, Jan J Heimans, Jaap C Reijneveld, Martin J B Taphoorn
BACKGROUND: During the end-of-life (EOL) phase of glioma patients, a rapid deterioration in neurological functioning may interfere with the oral intake of antiepileptic drugs (AEDs). We aimed to assess the feasibility of non-oral AED treatment in an out-of-hospital setting according to an expert-based guideline. METHODS: Glioma patients with a history of epilepsy, in whom further antitumor therapy was considered to be no longer meaningful, were recruited at two Dutch hospitals...
April 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Megan Corrigan, Suprat Saely Wilson, Jeremy Hampton
PURPOSE: The safety and efficacy of medications that may be administered via the intranasal route in adult patients in the prehospital and emergency department (ED) settings are reviewed. SUMMARY: When medications of appropriate molecular character and concentration are delivered intranasally, they are quickly transported across this capillary network and delivered to the systemic circulation, thereby avoiding the absorption-limiting effects of first-pass metabolism...
September 15, 2015: American Journal of Health-system Pharmacy: AJHP
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