Recognizing seizure clusters in the community: The path to uniformity and individualization in nomenclature and definition

Abstract

Seizure emergencies experienced by patients with epilepsy include status epilepticus and seizure clusters. Although an accepted definition of status epilepticus exists, no clear consensus definition of seizure clusters has emerged; this is further complicated by the appearance in the literature of various empirically based definitions that have been developed for clinical trial study designs. In general, patients with intractable epilepsy have been shown to have a significant risk for acute episodes of increased seizure activity called seizure clusters (also referred to as acute repetitive seizures, among other terms) that differ from their usual seizure pattern. Duration (e.g., number of hours or days) is often included in the definition of a seizure cluster; however, the duration may vary among patients, with some seizure clusters lasting ≥24 h and requiring long‐acting treatment for this period. In addition to seizure cluster duration, the time between seizures and possible acceleration in seizure frequency during the cluster may be important variables. The recognition and treatment of seizure clusters require urgent action because episodes that are not quickly and appropriately treated may lead to injury or progress to status epilepticus or potentially death. Most seizure clusters occur outside a medical facility (in the community) and treatment is usually administered by nonmedical individuals; therefore, health care providers may benefit from a clear description of these potential seizure emergencies that they can then use to educate patients and caregivers on the prompt and appropriate identification of seizure clusters and administration of rescue therapy. Here we explore why greater uniformity is needed in the discussion of seizure clusters. This exploration examines epidemiologic studies of seizure clusters and status epilepticus, inconsistencies in nomenclature and definitions for seizure clusters, practical application of seizure cluster terminology, and the potential use of acute seizure action plans and patient‐specific individualized definitions in the clinical setting.

Consequences: Bench to home

“…See Haut and Nabbout, Recognizing Seizure Clusters in the Community: The Path to Uniformity and Individualization in Nomenclature and Definition for more details regarding the clinical implications of seizure clusters. 57 A number of practical barriers to identifying patients at risk for seizure clusters exist. There is no clear consensus on the definition of a seizure cluster, which complicates identification in the limited time that clinicians have for patient consultations.…”

“…Patients who experience seizure clusters commonly have refractory epilepsy and higher rates of hospitalization, 1,2 leading to greater health care costs and demands on health care resources. See Haut and Nabbout, Recognizing Seizure Clusters in the Community: The Path to Uniformity and Individualization in Nomenclature and Definition for more details regarding the clinical implications of seizure clusters 57 …”

The Evaluation of the Efficacy and Safety of Midazolam Nasal Spray in Patients With Seizure Clusters: A Systematic Review and Meta-Analysis

“…And in case of no recovery in-between seizures, it may progress into status epilepticus, which becomes more critical and may lead to injury or death [ 8 ]. It has been reported that the prevalence of seizure clusters in outpatient and inpatient studies of patients having epilepsy is 13%-76% and 18%-61%, respectively [ 9 , 10 ]. It has been reported that patients having a history of seizure clusters have 2.5 times more risk for sudden unexplained death in epilepsy (SUDEP).…”

Rescue therapies for seizure clusters: Pharmacology and target of treatments

“…Ideal rescue therapies should be easy and safe to administer, be effective at small doses (with a large therapeutic index), and exhibit rapid onset of action that can be sustained for several hours. 5 Three rescue therapies are approved by the US Food and Drug Administration (FDA) for the acute treatment of intermittent, stereotypic episodes of frequent seizure activity (i.e., seizure clusters, acute repetitive seizures) that are distinct from the usual seizure pattern in patients with epilepsy (Table 1) [6][7][8] (please see Haut and Nabbout, Recognizing Seizure Clusters in the Community: The Path to Uniformity and Individualization in Nomenclature and Definition 9 for further discussion on seizure cluster definitions in this issue). Diazepam rectal gel (Diastat) was approved for patients ≥2 years of age in 1997.…”