Emerging treatments
Intramuscular midazolam
One Cochrane review has shown that intramuscular administration of midazolam may be more effective than intravenous lorazepam at terminating seizures in people with status epilepticus in the pre-hospital setting, without any increase in recurrence of seizures or adverse events.[35]
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Topiramate
Topiramate blocks voltage-gated sodium channels, enhances GABA transmission, blocks AMPA receptors of glutamate, and inhibits carbonic anhydrase. Reported effective in aborting status epilepticus in some patients when other medicines failed.[42]
Intranasal benzodiazepines
Diazepam nasal spray has been granted orphan drug status by the US Food and Drug Administration (FDA) for the treatment of acute repetitive seizures in all age groups. In a small retrospective study of stroke patients presenting with status epilepticus, intranasal diazepam compared favourably with the intravenous formulation.[43] Intranasal administration of diazepam may be a practical alternative to the conventional administration of acute medication in status epilepticus, especially in patients with no intravenous access. Intranasal midazolam is also in development.
Ganaxolone
Ganaxolone is a synthetic analogue of allopregnanolone, an endogenous neurosteroid that modulates the brain neurotransmitter GABA. In pre-clinical trials, intravenous ganaxolone yielded positive results in benzodiazepine-resistant status epilepticus.[44] The FDA has granted intravenous ganaxolone orphan drug designation for the treatment of status epilepticus.
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