WEDNESDAY, Aug. 29, 2001 (HealthDayNews) -- Treating seizure patients en route to the emergency room can significantly improve their chances of coming out of the attack before reaching the hospital, new research says.
The findings, which appear in the Aug. 30 issue of the New England Journal of Medicine, support recommendations that paramedics handle epilepsy and other seizures aggressively. Seizure bouts that last longer than about 30 minutes can cause brain damage from lack of oxygen.
Anti-seizure drugs such as diazepam, sold under the brand name Valium, help calm the attacks, but they can increase the risk of serious breathing and heart problems, which ambulances aren't well equipped to handle.
The latest study, led by Brian Alldredge, a pharmacologist at the University of California at San Francisco, compared two benzodiazepines in adults suffering from "status epilepticus," characterized by at least five minutes of unabated or repeat spasms and unconsciousness. About half the 205 patients were epileptics, while the rest had seizures resulting from heavy drinking, strokes, head trauma or other causes.
Sixty-six of the patients received injections of either 5 milligrams of Valium -- the standard for seizure care among paramedics -- and 68 were given 2 milligrams of a similar but less commonly used compound called lorazepam. The rest got sham injections.
Both drugs significantly cut the risk that patients would still be in status epilepticus when they reached the hospital, and lorazepam appeared to be somewhat more effective than Valium, the researchers say.
Only 21 percent of those who weren't treated were seizure-free when the ambulance arrived, while 43 percent of those who received Valium and nearly 60 percent of those on lorazepam had recovered. Neither drug seemed to increase the risk of breathing or circulation problems, the researchers say.
The authors say patients in status epilepticus when they arrive at the emergency department are twice as likely as those who arrive seizure-free to need intensive care.
Bill Brown, executive director of the National Registry of Emergency Medical Technicians in Columbus, Ohio, says Valium is the drug of choice for paramedics dealing with status epilepticus. But he says the decision about what medication to use is made by the state medical director and not a national body. "What is standardized is that there is some pharmacological intervention at the paramedic level," Brown says.
Seizures rank 47 of the top 123 medical conditions paramedics receive calls for, says Brown, himself an EMT.
Dawn Sharp, a Nebraska paramedic who teaches emergency medicine, says she gets roughly one seizure call a year from her base in Arlington, a rural town northeast of Omaha. "But in Omaha or Lincoln there are more calls," Sharp says.
In addition to administering anti-seizure drugs, paramedics also try to shield a patients from head trauma and ensure they get enough oxygen. Seizure victims often vomit at the end of the attack, so paramedics also make sure patients don't inhale their gastric contents, Brown says.
What To Do: For an overview of status epilepticus, try eMedicine.
To learn more about being a paramedic, try the National Registry of Emergency Medical Technicians.
