Neurology -- Correspondence for Sirven et al., 58 (12) 1739-1744

Correspondence published:

Reply to Letter to the Editor: Joseph I Sirven, D. W. Claypool, K. L. Sahs, D. M. Wingerchuk, J. J. Bortz, J. Drazkowski, R. Caselli and D. Zanick (16 August 2002)

Is there a neurologist on this flight?: Jack Kundin (16 August 2002)

Reply to Letter to the Editor 16 August 2002

Joseph I Sirven
Mayo Clinic Scottsdale AZ,
D. W. Claypool, K. L. Sahs, D. M. Wingerchuk, J. J. Bortz, J. Drazkowski, R. Caselli and D. Zanick
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Re: Reply to Letter to the Editor

Sirven.Joseph{at}mayo.edu Joseph I Sirven, et al.

We agree with Dr. Kundin's comments that some form of an antiepileptic drug should be made available on emergency medical kits. A rectal preparation of diazepam could be appropriate but administration and storage are likely to be potential challenges with this. The ideal preparation is an antiepileptic medication that is easily administrable with an immediate onset of action, a long shelf life, and few adverse effects. Perhaps, buccal or intranasal benzodiazepine preparations could meet these requirements. The decision whether to carry any antiepiletic drug are currently up to the discretion of each individual airline and not the Mayo consultants that advise air crews. Thus, it is important that the FAA mandate the presence of this drug as a requirement on emergency medical kits.

Is there a neurologist on this flight? 16 August 2002

Jack Kundin
San Mateo CA
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Re: Is there a neurologist on this flight?

kundin{at}sbcglobal.net Jack Kundin

The articles concerning in-flight neurologic emergencies were quite interesting. However, I noticed that, although parenteral diazepam is included in several emergency kits, none contained diazepam in a rectal gel form. Studies show this form of administration to be safe in the hands of properly trained non-medical persons. Moreover, pharmacokinetic studies show that cognitive effects were mild two hours post-administration and nearly gone four hours post-administration; i.e. often before the patient's luggage has arrived on the carousel. Shouldn't consultants at the Mayo Clinic's Department of Emergency Medicine and at individual airlines consider maintaining a supply of this medication aboard?
References:
1. Sirven JJ, Claypool DW, Sahs KL, et al. Is there a neurologist on this flight? Neurology 2002;58:1739-1744.
2. Moss AJ, Longstreth WT. In-flight neurologic emergencies. Neurology 2002;58:1717.
3. Brown L, Bergen DC, Kotagal P, Groves L, Carson D. Safety of Diastat when given at larger-than recommended doses for acute repetitive seizures. Neurology 2001;56:1112.
4. Cloyd JC, Lalonde R, Beniak TE, et al. A single blind, crossover comparison of the pharmokinetics and cognitive effects of a new rectal diazepam gel with intravenous diazepam. Epilepsia 1998:39:520-526.