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Seizure clusters: diagnostic and therapeutic advances

Anfallscluster: Fortschritte in Diagnostik und Therapie

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Abstract

Epilepsy affects 45.9 million people globally. For individuals with epilepsy who continue to have seizures, up to half experience seizure clusters. These seizure clusters have a significant impact, worsening the quality of life for those with epilepsy and their caregivers, and leading to increased healthcare utilization including emergency-department visits and admissions. The risk of premature death including sudden unexpected death in epilepsy (SUDEP) is also increased with seizure clusters. Newly emerging technologies that provide long-term ambulatory electroencephalographic recordings are creating full and accurate seizure histories, resulting in a greater appreciation of the prevalence of seizure clusters and the potential for prediction or identification of seizure clusters. It is hoped that the abundance of data will lead to not only improved clinical care of seizure clusters, but also improved understanding of the pathophysiological mechanisms underlying seizure clusters. Approved treatments, currently in the form of benzodiazepines delivered via rectal, intranasal, or buccal routes, are available. While all current rescue therapies demonstrate clinical efficacy, real-world effectiveness is determined based on the pharmacology of the active drug as well as on the ease and acceptability of drug delivery. Therefore, recently developed alternatives to rectal administration represent significant advances in our treatment armamentarium. With these new options, the utility of identifying seizure clusters and developing a seizure action plan increases, improving the care of individuals with epilepsy and seizure clusters.

Zusammenfassung

Weltweit sind 45,9 Mio. Menschen von Epilepsie betroffen. Bei den Menschen mit Epilepsie, die weiterhin Anfälle haben, kommt es bei bis zu 50 % zu Anfallsclustern. Diese Anfallsserien haben erhebliche Auswirkungen, verschlechtern die Lebensqualität der Epilepsiekranken und ihrer Betreuenden und führen zu einer erhöhten Inanspruchnahme des Gesundheitswesens, einschließlich Aufsuchen der Notaufnahmen und Krankenhauseinweisungen. Das Risiko eines vorzeitigen Todes, einschließlich des plötzlichen unerwarteten Todes bei Epilepsie (SUDEP), ist bei Anfallsclustern ebenfalls erhöht. Neue Technologien, die ambulante Langzeit-Elektroenzephalographie-Aufzeichnungen ermöglichen, erstellen vollständige und genaue Anfallsverläufe, was zu einer besseren Einschätzung der Prävalenz von Anfallsclustern und dem Potenzial zur Vorhersage oder Identifizierung von Anfallsserien führt. Es ist zu hoffen, dass die Fülle an Daten nicht nur zu einer verbesserten klinischen Behandlung von Anfallsclustern, sondern auch zu einem besseren Verständnis der pathophysiologischen Mechanismen führt, die diesen Anfallsclustern zugrunde liegen. Es stehen zugelassene Behandlungen zur Verfügung, derzeit in Form von Benzodiazepinen, die rektal, intranasal oder bukkal verabreicht werden. Obwohl alle derzeitigen Notfalltherapien klinisch wirksam sind, hängt die tatsächliche Wirksamkeit von der Pharmakologie des Wirkstoffs sowie von der Einfachheit und Akzeptanz der Verabreichung ab. Daher stellen die kürzlich entwickelten Alternativen zur rektalen Verabreichung einen bedeutenden Fortschritt in unserem Behandlungsarsenal dar. Mit diesen neuen Optionen steigt der Nutzen der Identifizierung von Anfallsserien und der Entwicklung eines Anfallsaktionsplans, was die Versorgung von Menschen mit epileptischen Anfallsclustern verbessert.

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Authors and Affiliations

  1. Department of Neuroscience, University of Wisconsin-Madison, 1111 Highland Ave, 53705, Madison, WI, USA

    Justus M. Zemberi

  2. University of Wisconsin School of Pharmacy, 777 Highland Ave, 53705, Madison, WI, USA

    Barry E. Gidal

  3. Department of Neurology, William S Middleton Memorial Veterans Hospital, 2500 Overlook Ter, 53705, Madison, WI, USA

    Robert J. Kotloski

  4. Department of Neurology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, 53705, Madison, WI, USA

    Robert J. Kotloski

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B.E. Gidal is a consultant for Aquestive, Eisai Inc., Greenwich, Neurelis, Inc. J.M. Zemberi and R.J. Kotloski declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Zemberi, J.M., Gidal, B.E. & Kotloski, R.J. Seizure clusters: diagnostic and therapeutic advances. Clin Epileptol 36, 266–272 (2023). https://doi.org/10.1007/s10309-023-00640-x

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  • DOI: https://doi.org/10.1007/s10309-023-00640-x

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