For parents, it may provide confidence in leaving children with caregivers or permitting activities outside the home such as school and afterschool activities, or enabling family trips away from home. Having a rescue medication available at home offers peace of mind and provides a self-management tool and a degree of personal control. Thus, the ability to treat them helps decrease worry. Seizures in these settings cause significant additional stress for the patient, family, and caregivers. Use of a medication that may stop or prevent the evolution of cluster seizures at home, school, or work may prevent transport to emergency rooms and admission. Call 911 if injury, cyanosis, or continued seizure longer than 10 minutes.” For instance, one example of a plan may state: “Place the patient in a safe place or position and give the designated rescue medication if there have been more than 2-3 seizures in 24 hours or if a seizure lasts longer than 5 minutes. It should outline the particular actions to take when seizures occur and when to possibly intervene with a medication. A Seizure Action Plan is developed with the health care provider and the patient and/or caregiver. A plan provides a “What to do and when to do it” that includes first aid and possible use of rescue medication. Having a Seizure Emergency Plan or Seizure Action Plan is a key step to improving a person’s and their caregivers’ sense of control and safety and to decrease the uncertainty during a time of high stress when seizures are occurring. Thus there are multiple reasons to stop or shorten a period of cluster seizures. People with clusters are more frequently transported to emergency rooms and have more hospital admissions. Patients with clusters have been shown to have higher death rates, and the occurrence of frequent seizures in short periods of time is associated with an increased incidence of post-ictal psychosis. In one reported study, status epilepticus occurred more frequently in persons with clusters than in people without clusters (40% versus 12%). Cluster seizures have been associated with an evolution into status epilepticus. It is important to recognize the pattern of cluster seizures and to treat it. The exact reason that clusters of seizures occur is not clear but may be related to a failure of inhibition of the epileptic discharge in the brain which may happen for multiple reasons. There is no identifiable trigger in about 30% of people. Patients and caregivers may recognize triggers for clusters: sleep deprivation, stress, missing medications, illness with fever, using alcohol or other nonmedical drugs. Clusters may happen rarely or may occur frequently. Cluster seizures may happen in children but also occur in adults more than 60 years old who have new-onset seizures. Studies using patient diaries have shown as high as 47% of patients reporting groups or clusters of 3 or more seizures in a 24 hour period. Perhaps as many as 20-30% of patients in specialized epilepsy centers show this pattern of increased seizures at some time. Cluster seizures occur more often in patients with focal epilepsy but can occur in generalized epilepsy as well. Cluster seizures may happen in patients with rare seizures as well. An example of this is a woman who only has her seizures in the few days around her menses. Cluster seizures are more likely to occur in patients who have more difficulty to control seizures or refractory epilepsy which is defined as having failed more than 2 seizure medications. On the other hand, there are some patients who may only experience all their seizures in a cluster. Patients may identify different time periods that they recognize as specific to themselves. Typically health care professionals used these terms to describe more than 2-3 seizures in 24 hours, or in some studies in 6-8 hours. They all mean that there is a pattern of increased seizure frequency or severity which is recognizable to the person/caregiver and which is not their usual seizure pattern. TYPES OF SEIZURES AND DURATIONS SERIALOther terms used in the past that all referred to the same thing were serial seizures, crescendo seizures, seizure flurries, recurrent seizures, or cyclical seizures. I am going to use the term cluster seizures in this article. The term now being used is Cluster Seizures or Acute Repetitive Seizures. Patients, caregivers, and professionals use many terms to convey what they mean when they talk about a period of increased seizure frequency. TYPES OF SEIZURES AND DURATIONS PROFESSIONALBy: Patricia Penovich, MD, EFMN Professional Advisory Board Member
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