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ABSTRACT OF THE WEEK

Journal of veterinary internal medicine/ American College of Veterinary Internal Medicine
Volume 31 | Issue 4 (July 2017)

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

J Vet Intern Med. July 2017;31(4):1149-1158.
M Charalambous1, SFM Bhatti2, L Van Ham3, S Platt4, N D Jeffery5, A Tipold6, J Siedenburg7, H A Volk8, D Hasegawa9, A Gallucci10, G Gandini11, M Musteata12, E Ives13, A E Vanhaesebrouck14
1 Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.; 2 Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.; 3 Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.; 4 Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.; 5 Small Animal Department, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX.; 6 Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany.; 7 Clinical Department for Small Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria.; 8 Department of Clinical Science and Services, Royal Veterinary College, London, UK.; 9 Department of Clinical Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan.; 10 Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy.; 11 Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy.; 12 Department of Clinical Veterinary Medicine, Faculty of Veterinary Medicine, University of Agricultural Science and Veterinary Medicine Iasi, Iasi, Romania.; 13 Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.; 14 Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

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.

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