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Rescue Therapies for Seizures

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Abstract

Most medical therapies for epilepsy consist of daily (or multiple-daily) dose, fixed-schedule, pharmacologic oral agents. Despite adherence, many patients continue to experience seizures. Various products have been discovered, designed, and marketed to serve as seizure-abortant therapies. These agents can be administered rapidly, as a “rescue” therapy, once a clinical seizure or cluster of seizures starts. Rescue medications are given as needed in an attempt to disrupt progression of a given seizure, and forestall what would otherwise be a more prolonged or more severe clinical event. Seizure-abortants also serve to aid in the management of seizure emergencies, such as prolonged, repetitive seizures, or status epilepticus. These compounds are not appropriate for all patients. Nevertheless, they do provide therapeutic benefit to several groups of patients: 1) those who perceive the onset of their seizures and have time to perform a self-intervention, 2) patients’ caregivers who administer the therapy when they witness the onset of an ictal event, and 3) patients who are in the midst of an out-of-the-hospital seizure emergency (a seizure cluster or status epilepticus). In this article we will review currently available and future rescue therapies for seizures: US Food and Drug Administration (FDA) approved and FDA nonapproved drugs, nonpharmacologic behavioral treatments, the vagus nerve stimulator and the NeuroPace RNS® System (Mountain View, CA).

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Dreifuss FE, Rosman NP, Cloyd JC, et al. A comparison of rectal diazepam gel and placebo for acute repetitive seizures. N Engl J Med. 1998;338(26):1869–75.

    Article  PubMed  CAS  Google Scholar 

  2. Johannessen S, Patsalos P, Tomson T, et al. In: Engel J, Pedley T, editors. In epilepsy: a comprehensive textbook. Second Editionth ed. Philadelphia: Lippinocott Williams & Wilkins; 2008. p. 1171–83.

    Google Scholar 

  3. Friedman D, French JA. Effects of intermittent levetiracetam dosing in a patient with refractory daily seizures. Neurology. 2006;66(4):590–1.

    Article  PubMed  Google Scholar 

  4. Wolf P. The role of nonpharmaceutic conservative interventions in the treatment and secondary prevention of epilepsy. Epilepsia. 2002;43 Suppl 9:2–5.

    Article  PubMed  Google Scholar 

  5. Zanchetti A, Wang SC, Moruzzi G. The effect of vagal afferent stimulation on the EEG pattern of the cat. Electroencephalogr Clin Neurophysiol. 1952;4(3):357–61.

    Article  PubMed  CAS  Google Scholar 

  6. Blum B, Magens J, Bental E, Liban E. Electroencephalographic studies in cats with experimentally produced hippocampal epilepsy. Electroencephalogr Clin Neurophysiol. 1961;13:340–53.

    Article  PubMed  CAS  Google Scholar 

  7. Chase MH, Sterman MB, Clemente CD. Cortical and subcortical patterns of response to afferent vagal stimulation. Exp Neurol. 1966;16(1):36–49.

    Article  PubMed  CAS  Google Scholar 

  8. O’Brien JH, Pimpaneau A, Albe-Fessard D. Evoked cortical responses to vagal, laryngeal and facial afferents in monkeys under chloralose anaesthesia. Electroencephalogr Clin Neurophysiol. 1971;31(1):7–20.

    Article  PubMed  Google Scholar 

  9. Puizillout JJ, Foutz AS. Characteristics of the experimental reflex sleep induced by vago-aortic nerve stimulation. Electroencephalogr Clin Neurophysiol. 1977;42(4):552–63.

    Article  PubMed  CAS  Google Scholar 

  10. Zabara J: Peripheral control of hypersynchronous discharge in epilepsy. Electroencephalogr Clin Neurophysiol 1985;61:SupplS162.

    Google Scholar 

  11. McHugh JC, Singh HW, Phillips J, et al. Outcome measurement after vagal nerve stimulation therapy: proposal of a new classification. Epilepsia. 2007;48:375–8.

    Article  PubMed  Google Scholar 

  12. Major P, Thiele EA. Vagus nerve stimulation for intractable epilepsy in tuberous sclerosis complex. Epilepsy Behav. 2008;13:357–60.

    Article  PubMed  Google Scholar 

  13. Cyberonics, Inc.: Epilepsy Physician’s Manual. http://www.vnstherapy.com/epilepsy/hcp/manuals/default.aspx. Accessed: September 25, 2008.

  14. Boon P, Vonck K, Van Walleghem P, et al. Programmed and magnet-induced vagus nerve stimulation for refractory epilepsy. J Clin Neurophysiol. 2001;18:402–7.

    Article  PubMed  CAS  Google Scholar 

  15. •• McMullan J, Sasson C, Pancioli A, Silbergleit R: Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Acad Emerg Med. 2010 Jun;17(6):575–82. Six studies with 774 subjects were included. For seizure cessation, midazolam, by any route, was superior to diazepam, by any route; non-IV midazolam was as effective as IV diazepam; and buccal midazolam was superior to rectal diazepam in achieving seizure control. This is the best available article comparing midazolam to diazepam as rescue therapies.

    Article  PubMed  Google Scholar 

  16. Scott RC, Besag FM, Neville BG. Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomized trial. Lancet. 1999;353(9153):623–6.

    Article  PubMed  CAS  Google Scholar 

  17. Scheepers M, Scheepers B, Clough P. Midazolam via the intranasal route: an effective rescue medication for severe epilepsy in adults with learning disability. Seizure. 1998;7(6):509–12.

    Article  PubMed  CAS  Google Scholar 

  18. Scheepers M, Scheepers B, Clarke M, et al. Is intranasal midazolam an effective rescue medication in adolescents and adults with severe epilepsy? Seizure. 2000;9(6):417–22.

    Article  PubMed  CAS  Google Scholar 

  19. • Holsti M, Dudley N, Schunk J, et al.: Intranasal midazolam vs. rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Pediatr Adolesc Med. 2010 Aug;164(8):747–53. A total of 92 caretakers gave intranasal midazolam and rectal diazepam during a child’s seizure. There was no detectable difference in efficacy between the study medications as a rescue medication for terminating seizures at home in pediatric patients with epilepsy. This article is important because it highlights the ease of use of midazolam.

    Article  PubMed  Google Scholar 

  20. • de Haan GJ, van der Geest P, Doelman G, et al.: A comparison of midazolam nasal spray and diazepam rectal solution for the residential treatment of seizure exacerbations. Epilepsia. 2010 Mar;51(3):478–82. Epub 2009 Oct 8. In 21 adult patients with medically refractory epilepsy, no difference was demonstrated in efficacy or time to effect between intranasal midazolam and rectal diazepam gel and the majority of patients and caregivers preferred the nasal spray over the rectal formulation. This article also demonstrates the benefits of midazolam in terms of ease of use and patient satisfaction.

    Article  PubMed  Google Scholar 

  21. ClinicalTrials.gov: Intranasal Midazolam Versus Rectal Diazepam for Treatment of Seizures. Available at http://clinicaltrials.gov/ct2/show/NCT00326612?term=intranasal+midazolam&rank=1. Accessed April 7, 2011.

  22. Troester MM, Hastriter EV, Ng YT: Dissolving oral clonazepam wafers in the acute treatment of prolonged seizures. J Child Neurol. 2010 Dec;25(12):1468–72. Epub 2010 Apr 22.

    Google Scholar 

  23. Sakata O, Onishi H, Machida Y. Clonazepam oral droplets for the treatment of acute epileptic seizures. Drug Dev Ind Pharm. 2008;34(12):1376–80.

    Article  PubMed  CAS  Google Scholar 

  24. Rowland AG, Gill AM, Stewart AB, et al. Review of the efficacy of rectal paraldehyde in the management of acute and prolonged tonic-clonic convulsions. Arch Dis Child. 2009;94(9):720–3.

    Article  PubMed  CAS  Google Scholar 

  25. Wolf P: Acute administration of benzodiazepines as part of treatment strategies for epilepsy. CNS Neuroscience and Therapeutics. 2010;00:1=7.

    Google Scholar 

  26. Anderson CT, Davis K, Baltuch G: An update on brain stimulation for epilepsy. Current Neurology and Neuroscience Reports. July, 2009.

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Disclosure

Conflicts of interest: V.S. Poukas: none; J.R. Pollard: has served as a consultant for H. Lundbeck A/S and for GlaxoSmithKline; C.T. Anderson: has served as a consultant to NeuroPace.

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Authors and Affiliations

  1. Penn Epilepsy Center, Department of Neurology, University of Pennsylvania, HUP, 3400 Spruce Street, 3 West Gates Pavilion, Philadelphia, PA, 19104, USA

    Valeriya S. Poukas, John R. Pollard & Christopher Todd Anderson

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  1. Valeriya S. Poukas
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  2. John R. Pollard
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  3. Christopher Todd Anderson
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Correspondence to Christopher Todd Anderson.

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Poukas, V.S., Pollard, J.R. & Anderson, C.T. Rescue Therapies for Seizures. Curr Neurol Neurosci Rep 11, 418–422 (2011). https://doi.org/10.1007/s11910-011-0207-x

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