癫痫在美国是一种常见的神经系统疾病,影响约1.2%的人口。一些癫痫患者可能会出现癫痫发作,这是与患者通常的癫痫发作模式不同的急性重复性癫痫发作。癫痫发作集群是不可预测的,对患者和护理人员(包括护理伙伴)来说是情感上的负担,并需要及时治疗以防止进展为严重的结果,包括癫痫持续状态和相关发病率(例如,撕裂,由于跌倒引起的骨折)和死亡率。可以使用社区使用的救援药物来终止癫痫发作,苯二氮卓类药物是抢救治疗的基石。尽管苯二氮卓类药物的有效性和快速治疗方法的重要性,多达80%的成年患者不使用抢救药物来治疗癫痫发作。这篇叙述性综述提供了用于治疗癫痫发作集群的救援药物的最新信息,重点是地西泮直肠凝胶的临床开发和研究计划,咪达唑仑鼻喷雾剂,和地西泮喷鼻剂.长期临床试验的结果表明,癫痫发作集群的治疗是有效的。鼻内苯二氮卓类药物在儿科和成人患者中提供易用性和患者和护理人员满意度。急性抢救治疗的不良事件被描述为轻度至中度,在长期安全性研究中,没有呼吸抑制的报道归因于治疗。实施急性癫痫发作行动计划以促进抢救药物的最佳使用,为改善癫痫发作集群的管理提供了机会。允许受影响的人更快地恢复正常的日常活动。
一些服用抗癫痫药物的癫痫患者可能仍然有癫痫发作。这些癫痫发作可能发生在集群中。癫痫群是紧急情况,需要迅速治疗以降低癫痫持续状态和住院的风险。此外,这些集群可能会有压力。批准的救援药物是地西泮直肠凝胶,咪达唑仑鼻喷雾剂,和地西泮喷鼻剂.它们都可以被家人和其他照顾者使用,和鼻喷雾剂在公共环境中可能是优选的。所有这些治疗方法都可以用于成人,但是每个孩子都有不同的年龄限制。总的来说,这些疗法没有得到充分利用;然而,所有这些都被证明可以有效地阻止癫痫发作,并且有轻度至中度的副作用。鼻部治疗为患者和护理人员(护理伙伴)提供易用性和满意度。然而,某些疗效和患者组的数据并非适用于所有治疗。癫痫发作行动计划旨在提供有关何时以及如何使用救援药物的分步说明。增加行动计划的使用可以改善癫痫发作集群的家庭治疗,并允许患者进行正常的日常活动并避免受伤或住院。
Epilepsy is a common neurological disorder in the United States, affecting approximately 1.2% of the population. Some people with epilepsy may experience seizure clusters, which are acute repetitive seizures that differ from the person\'s usual seizure pattern. Seizure clusters are unpredictable, are emotionally burdensome to patients and caregivers (including care partners), and require prompt treatment to prevent progression to serious outcomes, including status epilepticus and associated morbidity (e.g., lacerations, fractures due to falls) and mortality. Rescue medications for community use can be administered to terminate a seizure cluster, and benzodiazepines are the cornerstone of rescue treatment. Despite the effectiveness of benzodiazepines and the importance of a rapid treatment approach, as many as 80% of adult patients do not use rescue medication to treat seizure clusters. This narrative review provides an update on rescue medications used for treatment of seizure clusters, with an emphasis on clinical development and study programs for diazepam rectal gel, midazolam nasal spray, and diazepam nasal spray. Results from long-term clinical trials have shown that treatments for seizure clusters are effective. Intranasal benzodiazepines provide ease of use and patient and caregiver satisfaction in pediatric and adult patients. Adverse events attributed to acute rescue treatments have been characterized as mild to moderate, and no reports of respiratory depression have been attributed to treatment in long-term safety studies. The implementation of an acute seizure action plan to facilitate optimal use of rescue medications provides an opportunity for improved management of seizure clusters, allowing those affected to resume normal daily activities more quickly.
Some people with epilepsy who take antiseizure medications may still have seizures. These seizures might happen in clusters. Seizure clusters are emergencies that need to be treated quickly to lower the risk of status epilepticus and hospitalization. Also, these clusters can be stressful. Approved rescue medications are diazepam rectal gel, midazolam nasal spray, and diazepam nasal spray. They can all be used by family and other caregivers, and nasal sprays may be preferred in a public setting. All of these treatments can be used for adults, but each has a different age limit for children. Overall, these therapies are underused; however, all have been shown to work in stopping seizure clusters and have mild to moderate side effects. Nasal treatments offer ease of use and satisfaction for patients and caregivers (care partners). However, data for some effects and patient groups are not available for all treatments. Seizure action plans are designed to give step-by-step instructions about when and how to use rescue medication. Increased use of action plans may improve at-home treatment of seizure clusters and allow patients to perform their normal daily activities and avoid injury or hospitalizations.