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Abstracts

Optimizing Rescue Medication Prescribing Practices for Patients with Epilepsy: A Study on Current Trends and Opinions

Abstract number : 2.445
Submission category : 7. Anti-seizure Medications / 7E. Other
Year : 2025
Submission ID : 1357
Source : www.aesnet.org
Presentation date : 12/7/2025 12:00:00 AM
Published date :

Authors :
Presenting Author: Sarah Demko, APRN – Cleveland Clinic

Nicole Woodrich, PharmD, BCPS – Cleveland Clinic
Jean Khoury, MD – Cleveland Clinic
Shelly Maniar, MD – Cleveland Clinic
Alanna Balbi, MD – Cleveland Clinic

Rationale: Current guidelines emphasize the importance of prescribing rescue medications for patients at risk for prolonged seizures, yet variability in practice patterns persists. At our institution, we hypothesized that rescue medications may not consistently be prescribed when indicated, potentially leaving patients vulnerable to inadequate seizure management. This review surveys practicing providers and evaluates prescribing patterns for seizure rescue medications, with a focus on identifying and understanding barriers that limit their optimal use.  

Methods: This is a retrospective chart review of 98 adult patients presenting to establish care at our epilepsy center who were prescribed or continued on antiseizure medications at the time of visit. We assessed whether seizure rescue mediations were prescribed and collected clinical and demographic data included: age, sex, gender, weight, race, type of insurance coverage, type of epilepsy, duration of epilepsy, etiology, type of seizures, history of status and history of seizure clusters. Additionally, we distributed an electronic questionnaire to physicians and advanced practice providers at the epilepsy center to assess prescribing practices.  

Results:

Of the 98 patients, the most prevalent seizure type was focal at 49% (n=46), unknown type 41% (n=40) and generalized 12% (n=12). Sixty nine percent of patients had a history of generalized tonic-clonic seizure (n=68), 21% (n=21) had seizure clusters and 15% (n=15) status epilepticus, with a combined total of 74% of patients (n=73) having at least one of the three. Out of 98 patients, 18% (n=18) were prescribed seizure rescue medications: seven received clonazepam, nine intranasal midazolam and two intranasal diazepam. Most patients had insurance coverage, 43% commercial, 33% Medicare and/or 31% Medicaid.  

Based on questionnaire results from epileptologists, neurologists, pharmacists, and advanced practice providers, there was agreement on the use of rescue medication for patients with prolonged seizures (100%), seizure clusters (92%), and history of status epilepticus (90%) however less often for focal epilepsy with rare GTC (49%) or single prolonged GTC without confirmed epilepsy (35%).  The choice of medication was guided by patient/caregiver perspective (88%), cost/insurance coverage (80%), and epilepsy type (67%), with less emphasis on route (35%); FDA guidelines influenced only 35% of prescribers. 



Conclusions: This study highlights a misalignment between current prescribing patterns for seizure rescue medications and established guideline-based recommendations. Despite high-risk clinical histories, appropriate rescue therapy remains underutilized, influenced by perceived barriers such as caregiver competence, benzodiazepine stewardship concerns, and administrative burden. Optimizing prescribing practices will require targeted provider education, standardized protocols, and strategies to address practical barriers, ensuring that all eligible patients with epilepsy receive timely guideline-concordant rescue treatment. 

Funding: none

Anti-seizure Medications