Treatment of Status Epilepticus with Diazepam (Valium)*

Abstract

SUMMARY Valium has proved to be one of the most effective drugs we have used in the treatment of status epilepticus. We have given one or more injections intravenously or intramuscularly, and also used up to 100 mg daily in a slow intravenous drip. Most status are stopped in a few seconds or minutes, whether generalized or partial, convulsive or non‐convulsive. In the doses we used we met no respiratory nor cardiac side effects. Valium is, in our opinion, the drug of choice for the emergency treatment of all cases of status epilepticus. Moreover it enables to distinguish properly so‐called status which stops in most cases, from convulsive manifestations of cerebral “catastrophes” upon which it has no lasting effect. RÉASUMÉA Le Valium s'est reAveAleA eCtre une des drogues les plus efficaces que nous ayions utiliseAes dans le traitement des eAtats de mal eApileptiques. Nous avons pratiqueA une ou plusieurs injections par voie intraveineuse ou intramusculaire et nous avons eAgalement utiliseA jusqu'aG 100 mg par jour en perfusion lente intraveineuse. La plupart des eAtats de mal eApileptiques sont arreCteAs en quelques secondes ou minutes, qu'ils soient geAneAraliseAs ou partiels, convulsifs ou non convulsifs. Avec les doses utiliseAes, nous n'avons rencontreA aucun effet respiratoire ou cardique secondaire. Le Valium est, aG notre avis, la drogue de choix pour le traitement d'urgence de tous les cas d'eAtat de mal eApileptiques. De plus, il permet de distinguer les eAtats de mal proprement dits, qui s'arreCtent dans la plupart des cas, des manifestations convulsives de “catastrophes” ceAreAbrales sur lesquelles il n'a aucun effet durable.

Micromolar-affinity benzodiazepine receptors regulate voltage-sensitive calcium channels in nerve terminal preparations.

“…Furthermore, in preliminary studies, the Ca2 -channel antagonist, nitrendipine, effectively inhibited the [3H]FNZ photoaffinity labeling of the ,uM BZ binding sites. These results indicate that the Ca2+-channel antagonist properties of the BZs are mediated by the Plasma concentrations of DZ that produce clinical effects in rats and humans range from 0.05 to 50 ,uM (26)(27)(28), and the brain levels of DZ and other BZs were shown to be 2-8 times higher than corresponding blood concentrations in the mouse, rat, and guinea pig (29,30 (31), inhibiting maximal electric-shock-induced seizures in animals (13), and preventing kindling in rats (32). At submicromolar concentrations, DZ is effective in binding to nM BZRs but has no significant clinical effects on maximal electric-shockinduced seizures, kindling, or tonic-clonic seizures in humans (13,(29)(30)(31)(32) …”

Use of Diazepam in Treatment of Severe Convulsive Status Epilepticus

“…The results are summarized in Table II Henking (1965) used the intravenous route in all their cases, whereas Iborra (1965) and Gastaut et al (1965) used both the intravenous and the intramuscular routes. However, since the two routes were often used in the same patient it is difficult to conclude which was the more effective.…”

“…Until recently there have been comparatively few published accounts of its use in the treatment of status epilepticus. One of the earliest was that of Naquet et al (1965), and others were by Gastaut et al (1965), Iborra (1965), Pique and Henking (1965), Revol et al (1965), Bamberger and Matthes (1966), and Lombroso (1966).…”

Depression in Patients With Epilepsy

“…Generalised absence seizures were The benzodiazepines, diazepam and lorazepam, have proved useful given intravenously (Gastaut et al 1965;Waltregny and Dargent 1975), and diazepam per rectum either as a suppository or solution (Agurell et al 1975;Ifunthe-Kaas 1980), in the treatment of status epilepticus, but they are generally not used orally for chronic control as the doses needed to achieve anticonvulsant effects are large and give rise to unwanted side effects. Clonazepam is useful intravenously in status -87 - (Gastaut et al 1971) and is said to be useful orally in the amelioration of the majority of seizure types with only transient side effects (Fazio et al 1975). Other authors (Dreifuss et al 1975;Browne and Feldman 1980) -89 -From research in the area, the concept of the "therapeutic range" has emerged.…”

“…"d~ja: vu"), ideational disturbances, illusions, hallucinations or automatisms. The term "status epilepticus" is used "when a seizure persists so long or is repeated so often as to constitute an established and persistent epileptic condition for hours or days" (Gastaut et al 1971).…”