Intranasal Midazolam versus Rectal Diazepam for the Management of Canine Status Epilepticus: A Multicenter Randomized Parallel-Group Clinical Trial
Midazolam intranasal versus diazepam retal para o tratamento do status epiléptico canino: um ensaio clínico multicêntrico randomizado de grupos paralelos
M. Charalambous , S.F.M. Bhatti, L. Van Ham, S. Platt, N.D. Jeffery, A. Tipold, J. Siedenburg ,H.A. Volk, D. Hasegawa, A. Gallucci, G. Gandini, M. Musteata, E. Ives, A.E. Vanhaesebrouck
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.
Benzodiazepine; Dog; Emergency; Epileptic seizures
Benzodiazepina; Cão; Emergência; Ataques epilépticos