Outcomes of out-of-hospital treatment of impending tonic-clonic status epilepticus with diazepam nasal…

Cohort studyEpilepsia· Aug 2026

Outcomes of out-of-hospital treatment of impending tonic-clonic status epilepticus with diazepam nasal spray: A retrospective combined cohort analysis.

John M Stern, Leock Y Ngo, Eric B Segal … Adrian L Rabinowicz

EpilepsyCohort studyTreatmentQ1IF 5.3

Diazepam nasal spray terminated most out-of-hospital tonic-clonic status epilepticus by 30 minutes

Outcomes of out-of-hospital treatment of impending tonic-clonic status epilepticus with diazepam nasal spray: A retrospective combined cohort analysis.

John M Stern … Adrian L Rabinowicz

Epilepsia · Aug 2026 · Q1 in Neurology

Purpose

We assessed the timing, dosing, and effectiveness of diazepam nasal spray in a large dataset of seizures treated in the out-of-hospital setting, using as reference the International League Against Epilepsy criteria for tonic-clonic status epilepticus (SE) and its treatment.

Methods

We analyzed pooled data from two studies evaluating the use of diazepam nasal spray as acute treatment for seizures in the out-of-hospital setting, a phase 1/2a pharmacokinetics and safety study (patients aged 2-5 years) and a phase 3 long-term safety study (patients aged 6-65 years).

n = 402 episodes

Results

Nearly two-thirds of status epilepticus episodes stopped within 30 minutes of seizure onset

61.7%

SE termination by t2

49.8%

Termination ≤20 min po

More results

SE recurrence after SE termination was low, with <5% of tonic-clonic SE episodes followed by a recurrence in ≤24 h.

Rate of usage of ≥2 doses for tonic-clonic SE episodes was low (5% [20 seizure episodes]).

Serious treatment-emergent events of SE occurred in 6.6% of patients with tonic-clonic SE episodes.

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Conclusion

SIGNIFICANCE: These findings support the safety and effectiveness of diazepam nasal spray for treating episodes of tonic-clonic SE and strengthen the evidence of the benefits of immediate-use antiseizure medication for seizure emergencies, including early SE.

Outcomes of out-of-hospital treatment of impending tonic-clonic status epilepticus with diazepam nasal spray: A retrospective combined cohort analysis.

Outcomes of out-of-hospital treatment of impending tonic-clonic status epilepticus with diazepam nasal spray: A retrospective combined cohort analysis.

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