Authors :
First Author: Tracy Glauser, MD – Comprehensive Epilepsy Center, Cincinnati Children’s Hospital, Cincinnati, OH
Presenting Author: Lucretia Long, APRN, FAES – The Ohio State University Wexner Medical Center
Danielle Becker, MD, MS – Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH; Lucretia Long, ARPN-CNP, FAES – The Ohio State University Department of Neurology, Columbus, OH; Kamil Detyniecki, MD – Department of Neurology, University of Miami Miller School of Medicine, Miami, FL; Patricia Penovich, MD – Minnesota Epilepsy Group, Saint Paul, MN; Joseph Sirven, MD – Department of Neurology, Mayo Clinic, Jacksonville, FL; Jurriaan Peters, MD, PhD – Harvard Medical School and Boston Children’s Hospital, Boston, MA; Adrian Rabinowicz, MD – Neurelis, Inc., San Diego, CA; Enrique Carrazana, MD – Neurelis, Inc., San Diego, CA; University of Hawaii John A. Burns School of Medicine, Honolulu, HI
Rationale:
Discrete seizures can progress to continuous, prolonged seizure activity, which is less responsive to benzodiazepines (the cornerstone of rescue treatment). Therefore, treatment at the onset of a seizure emergency is advocated to reduce the likelihood of progression to prolonged seizures and status epilepticus. The burden of epilepsy consists of social, psychological, medical, financial, and physical variables, which contribute to the day-to-day challenges that patients, caregivers, and family members encounter. The value of prompt treatment for seizure emergencies to reduce the daily burden of epilepsy apart from preventing status epilepticus is unclear.
Methods:
A literature search was conducted to broadly identify articles that evaluated benefits associated with prompt treatment of seizure emergencies. The literature search was performed on May 11, 2023, using PubMed and included the following search terms: ([epilepsy OR seizure] AND [acute]) AND [treatment]) AND (benefit OR advantage OR quality of life). Articles not written in English were excluded.
Results:
A total of 861 articles were screened, and 22 were selected for full-text review. Study findings indicate that seizures can affect quality of life, reducing a person’s expectations to perform daily living activities. Additionally, unabated focal seizures with altered awareness as well as generalized seizures (including tonic-clonic) can lead to both neural and nonneural injuries. Prompt treatment with rescue medication was found to provide advantages, including empowering patients, caregivers, and family members. In clinical trials, patients and/or caregivers who used rescue medication to treat a seizure emergency experienced a reduction in anxiety, as well as less seizure worry and dysfunction related to one’s ability to perform daily activities. Lastly, lower epilepsy-related medical costs were noted in patients who used rescue medication to treat seizure emergencies vs those who did not.
Conclusions:
Prompt treatment of seizure emergencies is important to prevent progression to status epilepticus. Additionally, other negative outcomes that are often overlooked (including the emotional burden, physical injuries, and self-imposed limitations on daily activities that seizure emergencies cause) can be addressed by access to and use of prompt rescue treatment. Thus, the rationale in support of prompt treatment for seizure emergencies appears to extend beyond prevention of status epilepticus to include outcomes that constitute the day-to-day challenges of living with epilepsy.
Funding:
Neurelis, Inc.