Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA.
Northwest Florida Clinical Research Group, LLC, Gulf Breeze, FL, USA.
Expert Rev Neurother. 2023 May;23(5):425-432. doi: 10.1080/14737175.2023.2206568. Epub 2023 May 1.
Patients with epilepsy can experience seizure clusters (acute repetitive seizures), defined as intermittent, stereotypic episodes of frequent seizure activity that are distinct from typical seizure patterns. There are three FDA-approved rescue medications, diazepam rectal gel, midazolam nasal spray, and diazepam nasal spray, that can be administered to abort a seizure cluster in a nonmedical, community setting. Despite their effectiveness and safety, rescue medications are underutilized, and patient/caregiver experiences and perceptions of ease of use may constitute a substantial barrier to greater utilization.
The literature on rescue medications for seizure clusters is reviewed, including the effectiveness and safety, with an emphasis on ease and timing of treatment and associated outcomes. Barriers to greater utilization of rescue medication and the role of seizure action plans are discussed.
Intranasal rescue medications are easier to use and can be administered more rapidly than other routes (rectal, intravenous). Importantly, rapid administration of intranasal rescue medications has been associated with shorter durations of seizure activity as compared with rectal/intravenous routes. Intranasal rescue medications are also easy to use and socially acceptable. These factors potentially remove or reduce barriers to use and optimize the management of seizure clusters.
癫痫患者可能会经历癫痫发作群（急性反复性癫痫发作），其定义为间断出现的、刻板的、频繁癫痫发作活动的发作期，与典型的癫痫发作模式不同。有三种获得 FDA 批准的急救药物，即直肠用苯二氮䓬凝胶、鼻内用咪达唑仑喷雾剂和鼻内用苯二氮䓬喷雾剂，可用于在非医疗社区环境中终止癫痫发作群。尽管这些药物有效且安全，但仍未得到充分利用，而患者/照护者对易用性的体验和看法可能是阻碍其得到更多应用的重要因素。
本文回顾了用于癫痫发作群的急救药物的文献，包括其有效性和安全性，重点介绍了治疗的简便性和时机以及相关结果。还讨论了阻碍急救药物更广泛应用的因素以及癫痫行动计划的作用。
鼻内用急救药物比其他途径（直肠、静脉内）更易于使用且能更快给药。重要的是，与直肠/静脉内途径相比，鼻内给予急救药物与癫痫活动持续时间更短有关。鼻内用急救药物也易于使用且社会可接受。这些因素可能消除或减少使用障碍，并优化癫痫发作群的管理。
