Abstracts

Rationale: Consistent and well-defined terminology to describe seizure clusters is necessary for clinicians to reach an accurate diagnosis and to best assess whether or not treatment intervention is appropriate. Yet, it is not clear that a uniform term has been widely adopted. The need for uniform terminology is further warranted due to the multiple forms of rescue medications currently in development. The objective of this literature review was to determine the terms most commonly used to describe seizure clusters and evaluate their use over the years. Methods: A systematic review of PubMed filtered for human patients and clinical trials was performed on 15Sep2014 using the following 7 search terms: seizure cluster(s), cluster seizure(s), acute repetitive seizure(s), bout(s) of seizures, serial seizure(s), crescendo seizure(s), and seizure flurry(ies). Results were limited to publications in which the search term appeared in the title and/or abstract. The search was conducted both under no specific time frame (herein referred to as "all years") and filtered for trials published within the last 5 years. The number of results were then compared for all search terms. To determine changes in terminology over time, papers from the last 5 years were compared with papers published prior to 2009. Results: Of the 7 seizure emergency search terms, 3 did not yield any results through the PubMed title/abstract filter (bouts of seizures, crescendo seizures, and seizure flurries). The remaining 4 search terms—seizure clusters, cluster seizures, acute repetitive seizures, and serial seizures—resulted in a total of 114 non-mutually exclusive publications across all years. The most commonly used term was seizure clusters in 47 publications, followed by acute repetitive seizures (31), serial seizures (23), and cluster seizures (13). When comparing the 44 clinical trials published in the last 5 years with the 70 trials published prior to 2009, the proportion of papers reporting each of the 4 search terms changed over the years. For seizure clusters—the most common term—there was a 29% increase in use in the last 5 years (before 2009, 37% of publications; last 5 years, 48% of publications). A 36% increase was observed for cluster seizures, though the use of this term remained relatively low (before 2009, 10%; last 5 years, 14%). The use of acute repetitive seizures decreased by 13% over the years (before 2009, 29%; last 5 years, 25%) while the use of serial seizures decreased by 44% (before 2009, 24%; last 5 years, 14%). Conclusions: These data confirm the inconsistent nomenclature used to describe seizure clusters, and describe how the use of terminology has changed over the years. Though ""seizure clusters"" has consistently been the most commonly used phrase, its term and definition varies throughout publications. Therefore, a clinically relevant and uniform definition of the term seizure cluster is needed within the epilepsy community (ie, through expert consensus) to standardize patient diagnosis and allow for appropriate treatment strategies. Supported by Upsher-Smith Laboratories, Inc.