Medications used for seizure-emergency management in the UK community: A clinical practice research datalink...

Assess the prevalence, characteristics, and healthcare resource utilization (HCRU) of patients prescribed certain benzodiazepines for seizure-emergency management in the United Kingdom.

Retrospective cohort study using Clinical Practice Research Datalink (CPRD-Aurum) and Hospital Episode Statistics (HES) data that included patients with ≥1 recorded seizure-emergency medication prescription between 2016 and 2020. Patient characteristics were described for the whole sample. Inpatient, outpatient, and Accident and Emergency (A&E) encounters during 2019 were described. The 2019 prevalence of seizure-emergency medication prescription among patients with epilepsy was calculated.

In 2019, 6.7% (9336/139667) of CPRD-Aurum patients with epilepsy were prescribed seizure-emergency medication. Between 2016 and 2020, 26 534 patients with seizure-emergency medication were identified (mean/median age: 41.5/41.0 years [71.8% were adults]; 50.3% male). In this sample, the most prescribed seizure-emergency medication was buccal midazolam (60.6% of patients). Rectal diazepam was prescribed for 19.0%; oral benzodiazepines for 20.3%. Of the oral benzodiazepines prescribed for seizure-emergency management, oral diazepam was most common (97.5%). Buccal midazolam was prescribed both to children and adults (44.2%/55.8%); rectal diazepam and oral benzodiazepines mainly to adults (93.3%/99.5%). Among 11 594 patients with HES linkage in 2019, 25.1% experienced ≥1 epilepsy-specific inpatient hospitalization (median hospitalization days in patients with ≥1 hospitalization = 2.9 [IQR 12.0]); 35.7% had ≥1 neurology-specific outpatient visit (median visits in patients with ≥1 visit = 2.6 [3.4]); 8.7% had ≥1 epilepsy-related emergency attendance (median attendances in patients with ≥1 attendance = 3.0 [4.0]); 7.8% arrived in A&E by ambulance due to epilepsy (median arrivals in patients with ≥1 arrival = 2.2 [3.4]).

In 2019, 6.7% of patients with epilepsy were prescribed seizure-emergency medication. Nevertheless, patients continue to encounter challenges to manage seizure-related emergencies, as shown by high HCRU, suggesting that it may be time for a new treatment paradigm. The recently proposed concept of Rapid and Early Seizure Termination (REST) warrants further investigation.

In people with epilepsy, some seizures last too long and will not stop on their own, or may happen one after another, becoming emergencies that need medical attention; seizure-emergency medications are given to stop the seizure and prevent other medical problems. We looked at the share of people with epilepsy who had a seizure-emergency medication prescription in a UK database, and this group's use of health services. In 2019, 7% of people with epilepsy were prescribed a seizure-emergency medication. Use of health services was high in this group, highlighting the need for better treatment options.