Managing Acute Seizures: New Rescue Delivery Option and Resources to Assist School Nurses

Dean, Patricia; O’Hara, Kathryn; Brooks, Lai; Shinnar, Ruth C.; Bougher, Genei; Santilli, Nancy

doi:10.1177/1942602x211026333

Cited by 15 publications

(27 citation statements)

References 34 publications

(53 reference statements)

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“…Along with school nurses, education should be extended to teachers, administrators, and coaches 33 . School nurses may be called on to educate the student population 33 . The Epilepsy Foundation provides guidance for schools in its Seizure Safe Schools initiative, which recommends the following: training in first‐aid response for school employees, mandating an SAP in the student's file that is available to personnel responsible for the student, ensuring that US Food and Drug Administration‐approved prescribed medication is available to the student, and educating the student community about epilepsy 39…”

Section: Guidance For Developing Implementing and Updating An Asapmentioning

confidence: 99%

Introduction to use of an acute seizure action plan for seizure clusters and guidance for implementation

Patel

Becker

2022

Epilepsia

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It is important for patients with epilepsy and their caregivers, including care partners, to understand the patient's seizure clusters and what to do when they occur. In many instances, seizure clusters are unique to each patient. The knowledge gained from understanding a patient's seizure cluster or seizure pattern provides a foundation for taking prompt action to prevent worsening to prolonged seizures, status epilepticus, and potentially death. Seizure action plans (SAPs), which are similar to the disease‐related treatment action plans for other conditions, can be developed by a health care provider (HCP) in conjunction with the patient with epilepsy and/or caregivers, and SAPs are specifically customized for the individual patient and his or her seizure management. However, the current literature lacks unified guidance on how to design SAPs that will help prepare patients and caregivers for rapidly determining and initiating appropriate treatment of acute seizure emergencies in the community and at home. Here, we examine the current usage and value of SAPs for pediatric and adult patients with epilepsy, and we introduce the concept of the acute SAP (ASAP) for use specifically during seizure emergencies, such as seizure clusters. This type of standardized, simplified, and customized plan can rapidly and concisely provide patients and caregivers with a practical protocol to treat a seizure cluster consistently, appropriately, and in a timely manner. Details on potential content and formats of ASAPs are provided. Following this is a discussion of barriers to ASAP use that may affect HCPs or patients and caregivers, including lack of standardization, relevance, and personalization and pitfalls associated with technology. This leads into a discussion of guidance for developing, implementing, and updating ASAPs that suggests ways to address the barriers and ensure that the ASAP is best suited to the patient's needs.

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Section: Guidance For Developing Implementing and Updating An Asapmentioning

confidence: 99%

Introduction to use of an acute seizure action plan for seizure clusters and guidance for implementation

Patel

Becker

2022

Epilepsia

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“…Importantly, SAPs are underused in adult patients compared with pediatric patients, 60 who can be asked to have SAPs on file in school settings. 69 There are several practical barriers to greater utilization of SAPs/ASAPs by adult patients who practice selfcare. First, there is a lack of recommendations and support tools for health care providers, particularly guidance on incorporation of newly approved treatment options.…”

Section: Management and Selfmanagement Of Seizure Clustersmentioning

confidence: 99%

“…Other challenges for rescue medication exist, such as difficulties with insurance coverage, cost, need for prior authorization, and access through special pharmacies 79 . In the community setting, routes of administration (e.g., rectal) can be important considerations, particularly for adult and adolescent patients 69,80,81 …”

Section: Impact: Clinical Perspectivementioning

confidence: 99%

“…In the community setting, some adult patients may be familiar with seizure first aid, but their care partners may benefit from written specific and comprehensive guidance. Importantly, SAPs are underused in adult patients compared with pediatric patients, 60 who can be asked to have SAPs on file in school settings 69 …”

Section: Impact: Clinical Perspectivementioning

confidence: 99%

“…8 Rescue medications are key interventions included in SAPs/ASAPs for patients with seizure clusters. 8,69 Despite their benefits, rescue medications (e.g., benzodiazepines) appear to be underused, 73 which may contribute to overuse of emergency medical services. 2 Selection of a rescue medication should be customized to each patient, with consideration given to the safety and effectiveness with respect to seizure cluster duration.…”

Section: Management and Selfmanagement Of Seizure Clustersmentioning

confidence: 99%

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Consequences: Bench to home

Long

Dixon‐Salazar²

2022

Epilepsia

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Seizure clusters (also referred to as acute repetitive seizures) consist of several seizures interspersed with brief interictal periods. Seizure clusters can break down γ‐aminobutyric acidergic (GABAergic) inhibition of dentate granule cells, leading to hyperactivation. Functional changes to GABAA receptors, which play a vital neuroinhibitory role, can include altered GABAA receptor subunit trafficking and cellular localization, intracellular chloride accumulation, and dysregulation of proteins critical to chloride homeostasis. A reduction in neuroinhibition and potentiation of excitatory neurotransmission in CA1 pyramidal neurons represent pathological mechanisms that underlie seizure clusters. Benzodiazepines are well‐established treatments for seizure clusters; however, there remain barriers to appropriate care. At the clinical level, there is variability in seizure cluster definitions, such as the number and/or type of seizures associated with a cluster as well as the interictal duration between seizures. This can lead to delays in diagnosis and timely treatment. There are gaps in understanding between clinicians, their patients, and caregivers regarding acute treatment for seizure clusters, such as the use of rescue medications and emergency services. This lack of consensus to define seizure clusters in addition to a lack of education for appropriate treatment can affect quality of life for patients and place a greater burden on patient families and caregivers. For patients with seizure clusters, the sense of unpredictability can lead to continuous traumatic stress, during which patients and families live with a heightened level of anxiety. Clinicians can affect patient quality of life and clinical outcomes through improved seizure cluster education and treatment, such as the development and implementation of a personalized seizure action plan as well as prescriptions for suitable rescue medications indicated for seizure clusters and instructions for their proper use. In all, the combination of targeted therapy along with patient education and support can improve quality of life.

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Treatment of Seizure Clusters in Epilepsy: A Narrative Review on Rescue Therapies

et al. 2023

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Epilepsy is a common neurological disorder in the United States, affecting approximately 1.2% of the population. Some people with epilepsy may experience seizure clusters, which are acute repetitive seizures that differ from the person’s usual seizure pattern. Seizure clusters are unpredictable, are emotionally burdensome to patients and caregivers (including care partners), and require prompt treatment to prevent progression to serious outcomes, including status epilepticus and associated morbidity (e.g., lacerations, fractures due to falls) and mortality. Rescue medications for community use can be administered to terminate a seizure cluster, and benzodiazepines are the cornerstone of rescue treatment. Despite the effectiveness of benzodiazepines and the importance of a rapid treatment approach, as many as 80% of adult patients do not use rescue medication to treat seizure clusters. This narrative review provides an update on rescue medications used for treatment of seizure clusters, with an emphasis on clinical development and study programs for diazepam rectal gel, midazolam nasal spray, and diazepam nasal spray. Results from long-term clinical trials have shown that treatments for seizure clusters are effective. Intranasal benzodiazepines provide ease of use and patient and caregiver satisfaction in pediatric and adult patients. Adverse events attributed to acute rescue treatments have been characterized as mild to moderate, and no reports of respiratory depression have been attributed to treatment in long-term safety studies. The implementation of an acute seizure action plan to facilitate optimal use of rescue medications provides an opportunity for improved management of seizure clusters, allowing those affected to resume normal daily activities more quickly.

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Managing Acute Seizures: New Rescue Delivery Option and Resources to Assist School Nurses

Cited by 15 publications

References 34 publications

Introduction to use of an acute seizure action plan for seizure clusters and guidance for implementation

Introduction to use of an acute seizure action plan for seizure clusters and guidance for implementation

Consequences: Bench to home

Treatment of Seizure Clusters in Epilepsy: A Narrative Review on Rescue Therapies

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