The 30-minute duration has been the subject of debate, since it may delay aggressive therapy, particularly when prolonged duration can be predicted in the absence of therapy. Status epilepticus was previously broadly defined as seizure activity that continues for 30 minutes, or recurrent seizures without recovery between attacks.
Other approaches that were evaluated include buccal diazepam and staccato midazolam.
#Status epilepticus trial#
The efficacy of intramuscular diazepam delivered by autoinjector was demonstrated in a blinded controlled trial ( Abou-Khalil et al., 2013), but this did not lead to FDA approval or marketing. Intranasal diazepam was approved by the US FDA in 2020. Buccal midazolam is in wide clinical use in Europe and various countries ( Nakken and Lossius, 2011), but has not been approved in the United States. Rectal diazepam was the only FDA-approved treatment for out-of-hospital administration by nonmedical caregivers ( Cereghino et al., 1998), until intranasal midazolam spray was approved in 2019 ( Detyniecki et al., 2019). However more severe clusters, particularly those known to progress to severe prolonged seizures or status epilepticus, may require other routes of administration. Mild clusters can be treated with oral doses of benzodiazepines. This may determine the most appropriate treatment for seizure clusters. Such progression may be predictable for individual patients, based on their seizure history. Seizure clusters themselves may or may not progress to prolonged seizures or even status epilepticus.
Patients with seizure clusters are more likely to have a history of status epilepticus. Seizure clusters are more common in patients with drug-resistant epilepsy, particularly those with remote symptomatic epilepsy and extratemporal epilepsy. Seizure clusters may include any type of seizure and may vary in severity, but by definition there is complete recovery in between seizures.
#Status epilepticus serial#
Seizure clusters, also called acute repetitive seizures and serial seizures, are closely grouped seizures representing an increase in seizure frequency compared to baseline, usually occurring over the span of minutes to a couple days.
Joseph Jankovic MD, in Bradley and Daroff's Neurology in Clinical Practice, 2022 Seizure Clusters and Status Epilepticus
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