Abstracts

Rationale: Seizure clusters, or acute repetitive seizures, are a phenomenon experienced by about 20% of persons with epilepsy and are difficult to study given the lack of a clear definition (e.g., ≥3 seizures/24 hours, ≥2 seizures/6 hours, etc).¹ Several benzodiazepine formulations have been approved by the Food and Drug Administration for acute seizure treatment, including diazepam rectal gel, intranasal (IN) midazolam, and IN diazepam following placebo controlled trials.²   It remains unclear which patients may benefit from having rescue therapy for seizure clusters; thus, we examined differences in healthcare utilization in a large cohort of children with epilepsy either with or without cluster seizure rescue prescriptions.

Methods: We analyzed emergency department (ED) visits related to seizures in a cohort of children aged 0-18 years with (n=1679) or without (n=1537) prescriptions for seizure clusters (≥3 seizures/hour). All children had prescriptions for rescue therapy for seizures ≥5 minutes. Sociodemographic, epilepsy-related and health-related quality of life characteristics were collected and analyzed using Wilcoxon rank sum and Pearson chi-square tests. Due to the large number of participants, standardized mean differences (SMD) were computed to measure effect size independent of sample size. The probability of having any ED visits for seizures was modeled with univariable and multivariable logistic regression.

Results: IN midazolam (n=2886), IN diazepam (n=184) and rectal diazepam (n=145) were prescribed. The two groups were similar across most measured characteristics (Table 1). The only features with an SMD >0.2 (greater than small effect size) were seizure frequency in the last 28 days (0.22) and drug resistant epilepsy (0.38). The only measured characteristic associated with ED utilization on multivariable testing was higher acute social needs (Odds Ratio 1.4; p< 0.001 (Table 2).