■癫痫患者可能会出现癫痫发作(急性重复性癫痫发作),定义为间歇性,与典型的癫痫发作模式不同的频繁发作活动的刻板印象。有三种FDA批准的救援药物,地西泮直肠凝胶,咪达唑仑鼻喷雾剂,和地西泮喷鼻剂,可以用来终止非医疗中的癫痫发作,社区设置。尽管它们的有效性和安全性,救援药物没有得到充分利用,和患者/护理人员的经验和易用性的感知可能构成更大利用的实质性障碍。
■综述了关于癫痫发作群聚的救援药物的文献,包括有效性和安全性,强调治疗的容易性和时机以及相关结果。讨论了更多利用救援药物的障碍和癫痫发作行动计划的作用。
■鼻内救护药物更易于使用,并且比其他途径(直肠,静脉注射)。重要的是,与直肠/静脉途径相比,快速鼻内抢救药物的给药与较短的癫痫发作持续时间相关.鼻内救护药物也易于使用和社会接受。这些因素可能会消除或减少使用和优化癫痫发作群集管理的障碍。
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.