title: Rectal carbamazepine as effective long-acting treatment after cluster seizures and status epilepticus.
abstract: Carbamazepine (CBZ) is the gold standard antiepileptic drug (AED) for focal onset seizures. Despite CBZ being the benchmark AED, with readily available therapeutic drug monitoring, patients presenting with recurrent secondarily generalized tonic-clonic (or cluster) seizures or generalized tonic-clonic status epilepticus (SE) are primarily treated with other long-acting agents. The aim of the study was to examine the potential use of rectal (PR) CBZ as alternative long-acting treatment to parenteral AEDs following the termination of cluster seizures or SE with acute intravenous therapies. Oral CBZ syrup was given PR using 400-mg equivalent aliquots. Serum CBZ levels were requested after administration to confirm achievement of minimum therapeutic levels (total CBZ>20μmol·L(-1)). Where levels were subtherapeutic, the procedure was repeated using 400-mg CBZ bolus aliquots until therapeutic levels were achieved. Seven patients received PR CBZ to manage cluster seizures or SE following the initial termination of acute seizures with IV therapies including benzodiazepines. Six patients had no prior history of seizures, and 1 patient with a prior history was not taking AED therapy at the time of presentation. All patients subsequently remained seizure-free, and therapeutic CBZ levels were achieved in 6 of the 7 subjects within 5-10h of initial CBZ dosing. In conclusion, the present study reports 7 patients who were safely and effectively treated with PR CBZ, which proved to be a viable and safe alternative to parenteral AEDs for maintenance of seizure freedom.
authors: Department of Neurology, Liverpool Hospital and The South Western Sydney Clinical School, University of New South Wales (NSW), Sydney, NSW, Australia.
authors: Vishal
authors: V
authors: Patel
authors: Department of Neurology, Liverpool Hospital and The South Western Sydney Clinical School, University of New South Wales (NSW), Sydney, NSW, Australia.
authors: Dennis J
authors: DJ
authors: Cordato
authors: Department of Neurology, Liverpool Hospital and The South Western Sydney Clinical School, University of New South Wales (NSW), Sydney, NSW, Australia.
authors: Ashish
authors: A
authors: Malkan
authors: Department of Neurology, Liverpool Hospital and The South Western Sydney Clinical School, University of New South Wales (NSW), Sydney, NSW, Australia; Griffith University, Southport, Queensland, Australia; Strategic Health Evaluators, Sydney, NSW, Australia. Electronic address: Roy@royberan.com.
authors: Roy G
authors: RG
authors: Beran
mesh_terms: D000285:Administration, Rectal; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage*; D001569:Benzodiazepines / Q000627:therapeutic use; D002220:Carbamazepine / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000188:drug therapy*; D013226:Status Epilepticus / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000927:Anticonvulsants; D001569:Benzodiazepines; D002220:Carbamazepine
keywords: Administration; Carbamazepine; Rectal; Seizures