Immediate-use rescue medication and the epilepsy monitoring unit: experiences from an expert panel

People with epilepsy (PWE) may experience seizure clusters, broadly defined as ≥2 seizures that occur in close proximity. In epilepsy monitoring units (EMUs), seizure clusters can spontaneously occur during long-term videoelectroencephalogram monitoring (LTVEM) or as a result of antiseizure medication dose adjustments. In this survey, we examined the experiences and practices of expert clinicians with seizure clusters in EMUs.

A 55-item survey was sent to members of an Epilepsy Education Council who are epilepsy experts. Items described experiences, treatment practices, and negative outcomes with seizure clusters in EMUs.

Of the 15 experts (aged 43-77 y), 14 are physicians and 1 is an advanced practice provider; 14 work at level 4 epilepsy centers. The definition of seizure cluster varied across experts, from 2 seizures in 1 hour to 3 seizures over 24 hours. Twelve experts prescribe immediate-use rescue medication (RM) during EMU stay, usually a benzodiazepine. An intranasal route is preferred by 11 if intravenous access is unavailable. Nine experts have had a presurgical evaluation compromised owing to seizure clusters during LTVEM, and 12 have cared for PWE who required transfer to a higher-level care (eg, intensive care unit) owing to seizure clusters. Thirteen experts indicated they would follow expert consensus recommendations for immediate-use RMs in the EMU if available.

In the EMU, seizure clusters may compromise presurgical evaluations and require higher levels of care. Consensus recommendations are needed to guide patient-specific treatment practices before, during, and after EMU admission.