Prescriptions for seizure cluster rescue therapy are not associated with decreased pediatric ED utilization

Seizure clusters, or acute repetitive seizures, are a phenomenon often experienced by patients with epilepsy and pose a significant treatment challenge for clinicians. Several rescue medications have been approved by the Food and Drug Administration for the treatment of seizure clusters - including diazepam rectal gel, intranasal midazolam, and intranasal diazepam - which are commonly prescribed for prolonged seizures or status epilepticus (SE). Conflicting evidence exists relating to the impact of seizure cluster treatment on hospital care utilization and health-related quality of life (HRQoL). We hypothesized that children prescribed rescue medication specifically including an indication for seizure clusters would have fewer seizure-related Emergency Department (ED) visits compared to those prescribed rescue medications only for SE.

This study was a cross-sectional cohort study from a single pediatric center. A total of 3216 children with epilepsy and rescue medications were included. Measured characteristics included sociodemographic factors, epilepsy features, HRQoL, and healthcare utilization. We modeled the probability of having ED visits for seizures in the 12 months following prescriptions of rescue medication for either SE only or both SE and seizure clusters.

There was no difference in ED utilization between patients receiving a rescue prescription for SE only (n = 48, 3.1%) or both SE and seizure clusters (n = 64, 3.8%) (OR 1.12; 95% CI 0.74-1.71; p = 0.6). A multivariable model was created to evaluate factors associated with ED utilization. The acute social needs score was the only measured variable associated with increased odds of having a subsequent ED visit (OR 1.37; 95% CI 1.22-1.53; p < 0.001).

There was no difference in ED utilization between patients receiving a rescue medication prescription including seizure clusters and those only for SE. The social needs score was the only measured variable in this study associated with increased ED visits. These results highlight that prescribing rescue medications for cluster seizures may have less impact on healthcare utilization than acute social needs.

Seizure clusters are repetitive seizures that are poorly defined, and the consequences of treating them are unclear. While some providers prescribe benzodiazepines for use during these episodes, others do not. Using a large single-center database of over 3000 children, we found that having a prescription for a benzodiazepine to use during cluster seizures did not reduce emergency department (ED) use compared to patients with prescriptions for treating only life-threatening prolonged seizures. In this dataset, the only patient characteristic associated with ED utilization was the presence of an acute social need, such as food insecurity, suggesting that interventions targeting social needs may be more effective in reducing healthcare utilization in children with epilepsy.