Immediate-use Seizure Medication for Acute Repetitive Seizures in the Epilepsy Monitoring Unit: Experiences from an Expert Panel
Abstract number :
2.245
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2024
Submission ID :
987
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: William Tatum, MD – Mayo Clinic Florida
Evelyn Shih, MD, PhD – Neurelis, Inc.
Brin Freund, MD – Mayo Clinic Florida
Danielle Becker, MD, MS – Department of Neurology, Ohio State University Wexner Medical Center
R. Edward Faught, MD – Emory University
Edward Hogan, MD – Washington University in St. Louis
Andres Kanner, MD – Miller School of Medicine, University of Miami
David King-Stephens, MD – UC Irvine
Patricia Penovich, MD – Minnesota Epilepsy Group
M. Scott Perry, MD – Jane and John Justin Institute for Mind Health, Neurosciences Center, Cook Children's Medical Center
Eric Segal, MD – Hackensack University Medical Center, Hackensack Meridian School of Health, and Northeast Regional Epilepsy Group
Joseph Sirven, MD – Mayo Clinic, Jacksonville, FL, USA
John Stern, MD – University of California Los Angeles
James Wheless, BScPharm, MD, FAAP, FACP, FAAN, FAES – LeBonheur Children’s Hospital
Randa Jarrar, MD – Phoenix Children’s Hospital
Sandra Dewar, PhD, RN – VCU
Proleta Datta, MD PhD – Oregon Health & Science University
Rebecca Matthews, MD – Emory University School of Medicine, Atlanta, GA
Tracy Glauser, MD – Comprehensive Epilepsy Center, Cincinnati Children’s Hospital
Adrian Rabinowicz, MD – Neurelis, Inc.; Center for Molecular Biology and Biotechnology, Charles E. Schmidt College of Science, Florida Atlantic University
Enrique Carrazana, MD – Neurelis, Inc; John A. Burns School of Medicine, University of Hawaii
Rationale: A significant number of people with epilepsy have acute repetitive seizures or seizure clusters, typically defined as 2 or more seizures during a specified time period. However, there is a lack of expert consensus on precise clinical definitions and appropriate treatment. This pilot study examined practices of a group of experienced experts related to treatment of seizure clusters in Epilepsy Monitoring Units (EMUs).
Methods: A 55-item survey was developed to characterize seizure clusters and treatment practices that occurred during long-term video electroencephalography monitoring (VEM) at an EMU. Items described demographics of seizure clusters, treatment practices before, during, and after EMU stay, as well as negative outcomes associated with seizure clusters in this setting.
Results: Of the 15 respondents (aged 43–77 y), 14 (93.3%) are physicians, 14 (93.3%) work at level 4 Epilepsy Centers, and 11 (73.3%) spend 75%–100% of their day treating patients with epilepsy. Proportions of patients undergoing VEM who have drug-resistant epilepsy ranged from 25%–100% (median, 50%). A greater proportion of patients treated by respondents are prescribed rescue/immediate-use seizure medication (ISM) before VEM than patients treated by other clinicians (Figure). All respondents treat seizure clusters in the EMU at least sometimes. The number of seizures over a specific time duration that constitute a cluster varied across respondents, from 2 seizures in 1 h to 3 seizures over 24 h. Proportions of patients with seizure clusters during VEM ranged from 5%–25% (median, 15%). Nine respondents (60.0%) reported having a presurgical evaluation compromised due to seizure clusters during VEM, and 12 (80.0%) reported having had patients require higher-level care (eg, ICU). Nearly half (46.7%) have had a patient sustain a serious injury due to seizure clusters during EMU stay.
Fourteen respondents (93.3%) said they would treat seizure clusters in the EMU with a benzodiazepine, with an intranasal route preferred by 11 (73.3%) when the IV route is unavailable. Eight respondents (53.3%) felt that half-life was a more important consideration than the specific medication chosen, and lorazepam is preferred by a similar majority. Fourteen respondents (93.3%) newly prescribe ISMs on discharge, and 13 (86.7%) indicated they would follow expert consensus recommendations for use in the EMU if available.
Conclusions: In hospitalized settings with expert epilepsy clinicians, seizure clusters are of significant concern, often compromising presurgical evaluations, causing patient injury, and requiring transfer to a higher level of care for emergency management. Future research should include a broader and larger group of clinicians. The present results highlight the need for expert recommendations to standardize the definition of seizure clusters and guide treatment practices before, during, and after EMU admission.
Funding: Neurelis, Inc.
Clinical Epilepsy