EPI Talks: Seizure Clusters: The Role of Immediate Use Therapy-EPI Talks: Cluster Seizures

Video Transcription

Video Summary

The webinar covered seizure clusters, or acute repetitive seizures, and the role of immediate-use rescue therapy. Dr. Willis explained that seizure clusters are seizures occurring closer together or in a pattern different from a patient’s usual events. They are important because they increase risk of injury, emergency department visits, hospitalization, and possibly death, including SUDEP.<br /><br />He reviewed FDA-approved rescue benzodiazepines: rectal diazepam (Diastat), intranasal diazepam (Valtoco), and intranasal midazolam (Nayzilam). Diazepam has long been used safely, and intranasal formulations were developed to improve convenience and reduce the stigma of rectal administration. Midazolam intranasal was supported by randomized trial data. He emphasized that these treatments are individualized and do not require a fixed seizure duration before use; patients should follow a seizure action plan based on their typical pattern and caregiver judgment.<br /><br />He also discussed dosing, safety, and practical issues such as when to give a second dose, when to call 911, tolerance concerns, and insurance barriers. Overall, the message was that patients with seizure clusters benefit from having a clear, home-based rescue plan using fast-acting benzodiazepines to stop clusters early and avoid escalation.

Keywords

seizure clusters

acute repetitive seizures

rescue therapy

benzodiazepines

diazepam

midazolam

intranasal formulations

seizure action plan

SUDEP