Prehospital rescue treatment of cluster epileptic seizures and status epilepticus

Benzodiazepines play a crucial role in the management of cluster epileptic seizures and status epilepticus (SE), particularly in prehospital settings where timely intervention is essential to prevent prolonged seizures and minimize neurological damage. This review focuses on the efficacy, safety, and practical considerations of benzodiazepines use in these critical situations, with an emphasis on prehospital administration. Benzodiazepines, such as diazepam, lorazepam, and midazolam, are first-line treatments for SE due to their rapid onset of action, which facilitates seizure control. Midazolam, in particular, is favoured for prehospital use considering its versatility in administration routes (e.g., intramuscular, buccal, intranasal), enabling swift treatment when intravenous access is not immediately available. Clinical evidence shows that early benzodiazepines administration significantly improves outcomes in SE, reducing seizure duration, mortality, and the risk of progression to refractory SE. However, concerns remain regarding potential adverse effects such as respiratory depression, hypotension, and oversedation, which necessitate careful dosing and monitoring, especially in prehospital care; sometimes leading to sub-optimal use. This review summarizes benzodiazepines pharmacological characteristics and examines the balance between efficacy and safety, the importance of early intervention, and the benefits of various routes of administration. Additionally, challenges such as the availability of medications, training of emergency medical personnel, and development of standardized protocols are discussed. Ultimately, ensuring timely, effective treatment before hospital arrival by prehospital benzodiazepines use may improve outcomes for patients experiencing cluster epileptic seizures and SE.