Examining the patient and caregiver experience with diazepam nasal spray for seizure clusters: Results from an exit survey of a phase 3, open-label, repeat-dose safety study.

BACKGROUND: Ideal rescue treatments for acute treatment of seizure clusters should be easy to administer, so it is important to assess user perceptions of these treatments. Diazepam nasal spray is designed to have a rapid, noninvasive, and socially acceptable route of administration. Patient and caregiver (including care partner) responses to surveys from a phase 3 safety study of diazepam nasal spray are reported. METHODS: The study enrolled patients aged 6-65 years with seizure clusters. Surveys distributed to patients and caregivers at study end, completion, or discontinuation collected data on comfort using diazepam nasal spray outside the home, timing of administration and return to their usual selves, and comfort of use compared with rectal diazepam. Safety was assessed. RESULTS: Of 175 patients enrolled at the October 31, 2019, interim cutoff, 158 received diazepam nasal spray. Sixty-seven (42.4%) patients and 84 (53.2%) caregivers responded to the surveys (including 35 matched pairs). Most patients (78.8%, 52/66) responded that they were very comfortable doing activities outside the home with diazepam nasal spray available; 59.4% of patients returned to their usual selves within an hour of administration. Twenty-seven (40.3%) of these patients reported self-administration, 48% doing so at the first sign of a seizure. Administration of diazepam nasal spray was rated extremely or very easy by 93.8% of caregivers. Safety profile was consistent with diazepam rectal gel; no patient discontinued owing to treatment-emergent adverse events. Nasal discomfort was typically mild and transient. Among patients who had used diazepam rectal gel, most were not at all comfortable using it outside the home (86.7%) or at home (64.5%) compared with diazepam nasal spray, whereas caregivers reported that diazepam rectal gel was not at all easy to use compared with diazepam nasal spray. CONCLUSIONS: This survey from the phase 3 safety study of diazepam nasal spray shows that patients and caregivers were satisfied with, and more comfortable using, diazepam nasal spray than rectal diazepam in public. NCT02721069.

Use of intranasal rescue therapy for seizure clusters in students with epilepsy: Nurses' knowledge, perceptions, and practice.

School nurses play a crucial role in the prompt, appropriate response to epilepsy-related seizure emergencies among students in the school setting. Two intranasal benzodiazepine rescue therapies are now approved and offer potential benefits of being easy to use and socially acceptable. In July 2021, a survey was sent to 49,314 US school nurses to assess knowledge, perceptions, and practice with seizure rescue therapy. Responses were received from 866 (1.8% response rate). Of respondents, 45.7% had used rectal diazepam gel; 9.3%, midazolam nasal spray; and 6.0%, diazepam nasal spray. The majority (58.7%) had not delegated authority to administer rescue therapy, with state/local regulations and lack of willingness of school personnel being the most common barriers to delegation (37.7% and 20.1%, respectively). Additional training of nurses and school staff and progress on delegation policies may help optimize appropriate use of intranasal rescue therapy for seizures and enhance care of students with epilepsy in schools.

Hinge Strut: A New Septal Strut for Nasal Tip Projection, Definition, and Stability in Latino Noses.

Background: Obtaining ideal support to maintain the nasal tip has been investigated in several rhinoplasty studies. We aimed to describe a support technique, namely the use of a "hinge strut" (HS) for the nasal tip in Latino noses and to evaluate nasolabial angles at 6-months follow-up. Methods: In total, 46 Latino patients who had undergone rhinoplasty using the HS technique between June 2021 and June 2022 were recruited in Lima, Peru. All patients had nasolabial angle measurements taken preoperatively and at 1, 3, and 6 months postoperatively in active and passive positions to evaluate angle changes during this 6-month period. Results: We evaluated 38 women and six men aged 18-45 years (mean age, 25.74 years). In the passive position, the mean nasolabial angles were 91.5 degrees preoperatively and 106, 104, and 103 degrees at 1, 3, and 6 months, respectively, postoperatively. In the active position, the mean nasolabial angles were 85.5 degrees preoperatively and 102.6, 99.1, and 98.1 degrees at 1, 3, and 6 months, respectively, postoperatively (P < 0.0001, using Friedman chi-square test). Conclusions: The HS technique is safe and reproducible, with nasal tip maintenance and an adequate angle elevation trend observed at 6-months follow-up. Further studies and longer observation times are necessary to determine longer-term outcomes.