Rectal Valium for Seizures

Dreifuss et al conducted a randomized, double-blind, parallel-group, placebo-controlled study of home-based treatment for acute repetitive seizures. Patients were randomly assigned to receive either rectal diazepam gel, at doses ranging from 0.2 to 0.5 mg per kilogram of body weight on the basis of age, or a placebo. Children received one dose at the onset of acute repetitive seizures and a second dose four hours later. Adults received three doses; one dose at onset, and two more doses 4 and 12 hours after onset. Treatment was administered by a care giver, such as a parent, who had received special training. The number of seizures after the first dose was counted for 12 hours in children and for 24 hours in adults.

Of 125 study patients (64 assigned to diazepam and 61 to placebo) with a history of acute repetitive seizures, 91 (47 children and 44 adults) were treated for an exacerbation of seizures during the study period. Analysis showed diazepam to be superior to placebo in reducing seizure frequency in both children and adults, but only in children was it superior with regard to improvement in overall outcome. Thirty-five patients reported at least one adverse effect of treatment; somnolence was the most frequent. Respiratory depression was not reported.

(Dreifuss F. A comparison of rectal diazepam gel and placebo for acute repetitive seizures. N Eng J Med 1998; 338:1869-75)

COMMENT: Acute repetitive seizures require urgent treatment. Rectal diazepam gel is a promising therapy. However, the rectal route for medication is not reliable in children with fecal impactions. Unfortunately, a fair number of individuals who might benefit are multihandicapped special education students with chronic constipation.