RAMPART TRIAL-Rapid Anticonvulsant Medication Prior to Arrival Trial

The RAMPART Trial

Status epilepticus is a life-threatening medical emergency that occurs when a seizure lasts for more than 5 minutes or when there are multiple seizures without a return to consciousness in between. It is important to treat status epilepticus as quickly as possible, as the longer it goes untreated, the greater the risk of brain damage and death.

The RAMPART trial (Rapid Anticonvulsant Medication Prior to Arrival Trial) was a randomized clinical trial that compared the efficacy of intramuscular (IM) midazolam to intravenous (IV) lorazepam in the prehospital treatment of status epilepticus. The trial enrolled 1,080 adults and children with status epilepticus who were treated by paramedics.

The primary outcome of the trial was the proportion of patients who had seizure cessation within 10 minutes of receiving the first dose of medication. The secondary outcomes included the proportion of patients who had seizure cessation within 20 minutes, 30 minutes, and 60 minutes of receiving the first dose of medication, as well as the proportion of patients who had a favorable outcome at 24 hours.

The results of the RAMPART trial showed that IM midazolam was noninferior to IV lorazepam for the primary outcome of seizure cessation within 10 minutes. The proportion of patients who had seizure cessation within 10 minutes was 73% in the IM midazolam group and 63% in the IV lorazepam group.

The RAMPART trial also showed that IM midazolam was associated with a faster time to seizure cessation than IV lorazepam. The median time to seizure cessation was 3.3 minutes in the IM midazolam group and 1.6 minutes in the IV lorazepam group.

The results of the RAMPART trial suggest that IM midazolam is a safe and effective treatment for status epilepticus in the prehospital setting. IM midazolam is also faster acting than IV lorazepam, which could lead to better outcomes for patients with status epilepticus.

The findings of the RAMPART trial have been incorporated into the American Epilepsy Society's guidelines for the treatment of status epilepticus. The guidelines recommend that IM midazolam be used as the first-line treatment for status epilepticus in the prehospital setting.

New Treatments for Seizure Control

In addition to IM midazolam, there are a number of other new treatments for seizure control that are being developed. These include:

• Percept PC: This is a deep brain stimulation device that is approved by the FDA for the treatment of epilepsy. The device is implanted in the thalamus, a part of the brain that is involved in controlling seizures.
• Epilepsy vaccines: These are vaccines that are designed to prevent seizures. Epilepsy vaccines are still in the early stages of development, but they have the potential to revolutionize the treatment of epilepsy.
• Gene therapy: Gene therapy is a technique that involves replacing or repairing defective genes. Gene therapy is being investigated as a potential treatment for a number of diseases, including epilepsy.

The development of new treatments for seizure control is a promising area of research. These new treatments have the potential to improve the quality of life for people with epilepsy and to reduce the risk of death from status epilepticus.