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Rescue Treatments for Seizure Clusters
Robert J Kotloski1, Barry E Gidal2
1Department of Neurology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705-2281, USA; Department of Neurology, William S Middleton Memorial Veterans Hospital, 2500 Overlook Ter, Madison, WI, 53705, USA.
Rescue therapies for seizure clusters aim to prevent further seizures. Approved options include diazepam rectal gel and intranasal midazolam or diazepam, offering rapid and socially acceptable administration.
Area of Science:
- Neurology
- Pharmacology
Background:
- Seizure clusters require prompt treatment to prevent complications like status epilepticus.
- Rescue therapies are essential components of seizure action plans (SAPs).
Purpose of the Study:
- To review approved and off-label rescue therapies for seizure clusters.
- To compare the administration, onset, and tolerability of different seizure cluster treatments.
Main Methods:
- Review of approved intranasal and rectal benzodiazepine formulations.
- Discussion of off-label intranasal and oral benzodiazepine use for seizure clusters.
Main Results:
- Diazepam rectal gel is effective but may face social barriers.
- Intranasal midazolam and diazepam offer rapid, socially acceptable, and potentially self-administered alternatives.
- Off-label benzodiazepines have less characterized bioavailability and tolerability.
Conclusions:
- Intranasal benzodiazepines represent a promising advancement in seizure cluster rescue therapy.
- Ease of administration and social acceptability are key advantages of intranasal formulations.
- Further characterization of off-label agents is needed.
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