Immediate-use rescue medication and the epilepsy monitoring unit: experiences from an expert panel.

Background: People with epilepsy (PWE) may experience seizure clusters, broadly defined as ≥2 seizures that occur in close proximity. In epilepsy monitoring units (EMUs), seizure clusters can spontaneously occur during long-term videoelectroencephalogram monitoring (LTVEM) or as a result of antiseizure medication dose adjustments. In this survey, we examined the experiences and practices of expert clinicians with seizure clusters in EMUs.

Methods: A 55-item survey was sent to members of an Epilepsy Education Council who are epilepsy experts. Items described experiences, treatment practices, and negative outcomes with seizure clusters in EMUs.

Results: Of the 15 experts (aged 43-77 y), 14 are physicians and 1 is an advanced practice provider; 14 work at level 4 epilepsy centers. The definition of seizure cluster varied across experts, from 2 seizures in 1 hour to 3 seizures over 24 hours. Twelve experts prescribe immediate-use rescue medication (RM) during EMU stay, usually a benzodiazepine. An intranasal route is preferred by 11 if intravenous access is unavailable. Nine experts have had a presurgical evaluation compromised owing to seizure clusters during LTVEM, and 12 have cared for PWE who required transfer to a higher-level care (eg, intensive care unit) owing to seizure clusters. Thirteen experts indicated they would follow expert consensus recommendations for immediate-use RMs in the EMU if available.

Conclusions: In the EMU, seizure clusters may compromise presurgical evaluations and require higher levels of care. Consensus recommendations are needed to guide patient-specific treatment practices before, during, and after EMU admission.