Seizure Clusters: Current Concepts in Definition and Treatment

Area of Science:

• Neurology
• Clinical Pharmacology

Background:

• Seizure clusters (SCs) are a critical neurological event with increased risks.
• Heterogeneous management of SCs stems from undefined criteria and varied care settings.

Purpose of the Study:

• To review and analyze the treatment of seizure clusters.
• To compare efficacy and safety across outpatient, ED, and EMU settings.
• To identify gaps and recommendations for SC management.

Main Methods:

• Literature review of 32 original articles on SC treatment.
• Analysis focused on definitions, efficacy, and adverse events.
• Categorization by clinical scenarios: outpatient, Emergency Department (ED), and Epilepsy Monitoring Units (EMUs).

Main Results:

• Outpatient SC treatment shows comparable efficacy for diazepam nasal spray, midazolam nasal spray, and oral lorazepam, though limited by study heterogeneity.
• Inpatient management aligns with status epilepticus protocols, favoring IV benzodiazepines and subsequent antiseizure medications.
• Empirical ED definitions (e.g., >3 seizures/24h) aid timely interventions.

Conclusions:

• Patient-specific Acute Seizure Action Plans (ASAPs) with individualized SC definitions are recommended for outpatient care.
• Geographic drug availability impacts treatment standardization.
• Inpatient and ED management show greater consensus than outpatient settings.