Emergency Management of Seizure Clusters

Seizure clusters—defined as two or more seizures within a 24-hour period separated by recovery of consciousness—represent a critical intermediate state between isolated convulsions and status epilepticus. Rapid identification and intervention are essential to avert prolonged neurological insult, reduce emergency transport and hospital admission, and enhance patient and caregiver outcomes. Emergency management integrates patient-specific seizure action plans, risk stratification based on seizure type and post-ictal recovery, and coordinated care pathways involving community responders and hospital teams. The development of intranasal and buccal benzodiazepine formulations has facilitated non-invasive, user-friendly rescue therapies that can be administered by non-medical caregivers, ensuring prompt cessation of cluster episodes. Beyond pharmacological advances, emphasis on caregiver education, standardised protocols for dose timing, and clear communication channels with emergency services underpins global efforts to harmonise care. Future priorities include refining predictive models to anticipate cluster onset, tailoring interventions to individual pharmacokinetic profiles, and strengthening integration of prehospital and in-hospital treatment algorithms to improve both acute and long-term outcomes.

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Emergency Management of Seizure Clusters publication trend

The graph below shows the total number of articles in emergency management of seizure clusters across all publications each year (not limited to Nature Index journals).

Technical terms

Status epilepticus: A prolonged seizure or series of seizures without return to baseline consciousness, typically lasting more than five minutes, constituting a medical emergency.

Seizure cluster: A grouping of two or more seizures occurring within a defined period (commonly 24 hours) with recovery between events, distinct from isolated or continuous seizures.

Rescue medication: An acute, often fast-acting therapy administered to halt or attenuate seizure clusters outside routine maintenance treatment.

Intranasal administration: Delivery of drugs via the nasal cavity, offering rapid systemic uptake through the vascularised mucosa and avoiding gastrointestinal metabolism.

Pharmacokinetics: The study of drug absorption, distribution, metabolism and excretion, which informs onset, peak action and duration critical to emergency management.

Seizure action plan: A tailored, written guide detailing seizure recognition, dosage and timing of emergency medications, and instructions for caregivers and healthcare providers.

References

1. Seizure Clusters: Morbidity and Mortality. Frontiers in Neurology (2021).
2. Short-Term Impact of Seizures and Mitigation Opportunities. Current Neurology and Neuroscience Reports (2024).
3. Time Is Brain: Acute Control of Repetitive Seizures and Status Epilepticus Using Alternative Routes of Administration of Benzodiazepines. Journal of Clinical Medicine (2021).
4. A Short Review on the Intranasal Delivery of Diazepam for Treating Acute Repetitive Seizures. Pharmaceutics (2020).
5. Evaluation of Pharmacokinetics and Dose Proportionality of Diazepam After Intranasal Administration of NRL‐1 to Healthy Volunteers. Clinical Pharmacology in Drug Development (2020).
6. Consistent safety and tolerability of Valtoco® (diazepam nasal spray) in relationship to usage frequency in patients with seizure clusters: Interim results from a phase 3, long‐term, open‐label, repeat‐dose safety study. Epilepsia Open (2021).
7. Individualized Seizure Cluster Prediction Using Machine Learning and Chronic Ambulatory Intracranial EEG. IEEE Transactions on NanoBioscience (2023).