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Maltseva M, Rosenow F, von Podewils F, Habermehl L, Langenbruch L, Bierhansl L, Knake S, Schulz J, Gaida B, Kämppi L, Mann C, Strzelczyk A. Predictors for and use of rescue medication in adults with epilepsy: A multicentre cross-sectional study from Germany. Seizure 2024; 118:58-64. [PMID: 38642445 DOI: 10.1016/j.seizure.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/06/2024] [Accepted: 04/06/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Seizure clusters, prolonged seizures, and status epilepticus are life-threatening neurological emergencies leading to irreversible neuronal damage. Benzodiazepines are current evidence-based rescue therapy options; however, recent investigations indicated the prescription of mainly unsuitable benzodiazepines and inappropriate use of rescue medication. OBJECTIVE To examine current use, satisfaction, and adverse events concerning rescue medication in patients with epilepsy in Germany. PATIENTS AND METHODS The study was conducted at epilepsy centres in Frankfurt am Main, Greifswald, Marburg, and Münster between 10/2020 and 12/2020. Patients with an epilepsy diagnosis were assessed based on a questionnaire examining a 12-month period. RESULTS In total, 486 patients (mean age: 40.5, range 18-83, 58.2 % female) participated in this study, of which 125 (25.7 %) reported the use of rescue medication. The most frequently prescribed rescue medications were lorazepam tablets (56.8 %, n = 71 out of 125), buccal midazolam (19.2 %, n = 24), and rectal diazepam (10.4 %, n = 13). Seizures continuing for over several minutes (43.2 %, n = 54), seizure clusters (28.0 %, n = 35), and epileptic auras (28.0 %, n = 35) were named as indications, while 28.0 % (n = 35) stated they administered the rescue medication for every seizure. Of those continuing to have seizures, 46.0 % did not receive rescue medication. On average, rescue medication prescription occurred 7.1 years (SD 12.7, range 0-66) after an epilepsy diagnosis. CONCLUSIONS Unsuitable oral benzodiazepines remain widely prescribed for epilepsy patients as rescue medication. Patients also reported inappropriate use of medication. A substantial proportion of patients who were not seizure-free did not receive rescue medication prescriptions. Offering each patient at risk for prolonged seizures or clusters of seizures an individual rescue treatment with instructions on using it may decrease mortality and morbidity and increase quality of life. .
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Affiliation(s)
- Margarita Maltseva
- Goethe University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany; Alberta Children's Hospital Research Institute & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Felix Rosenow
- Goethe University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix von Podewils
- University Hospital Greifswald, Epilepsy Center Greifswald, Department of Neurology, Greifswald, Germany
| | - Lena Habermehl
- Philipps-University Marburg, Epilepsy Center Hessen, Department of Neurology, Marburg, Germany
| | - Lisa Langenbruch
- University of Münster, Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology, Münster, Germany; Klinikum Osnabrück, Department of Neurology, Osnabrück, Germany
| | - Laura Bierhansl
- University of Münster, Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology, Münster, Germany
| | - Susanne Knake
- Philipps-University Marburg, Epilepsy Center Hessen, Department of Neurology, Marburg, Germany
| | - Juliane Schulz
- University Hospital Greifswald, Epilepsy Center Greifswald, Department of Neurology, Greifswald, Germany
| | - Bernadette Gaida
- University Hospital Greifswald, Epilepsy Center Greifswald, Department of Neurology, Greifswald, Germany
| | - Leena Kämppi
- Helsinki University Hospital and University of Helsinki, Epilepsia Helsinki, European Reference Network EpiCARE, Department of Neurology, Helsinki, Finland
| | - Catrin Mann
- Goethe University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Goethe University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
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Lowe AA, Gerald JK, Clemens C, Gaither C, Gerald LB. Medication Administration Practices in United States' Schools: A Systematic Review and Meta-synthesis. J Sch Nurs 2021; 38:21-34. [PMID: 34223784 DOI: 10.1177/10598405211026300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Schools often provide medication management to children at school, yet, most U.S. schools lack a full-time, licensed nurse. Schools rely heavily on unlicensed assistive personnel (UAP) to perform such tasks. This systematic review examined medication management among K-12 school nurses. Keyword searches in three databases were performed. We included studies that examined: (a) K-12 charter, private/parochial, or public schools, (b) UAPs and licensed nurses, (c) policies and practices for medication management, or (d) nurse delegation laws. Three concepts were synthesized: (a) level of training, (b) nurse delegation, and (c) emergency medications. One-hundred twelve articles were screened. Of these, 37.5% (42/112) were comprehensively reviewed. Eighty-one percent discussed level of training, 69% nurse delegation, and 57% emergency medications. Succinct and consistent policies within and across the United States aimed at increasing access to emergency medications in schools remain necessary.
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Affiliation(s)
- Ashley A Lowe
- Asthma & Airway Disease Research Center, 22165University of Arizona, Tucson, AZ, USA
| | - Joe K Gerald
- Department of Community Environment and Policy, Mel and Enid Zuckerman College of Public Health, Asthma & Airway Disease Research Center, 8041University of Arizona, Tucson, AZ, USA
| | - Conrad Clemens
- Department of Pediatrics, College of Medicine, 20878University of Arizona, Tucson, AZ, USA
| | | | - Lynn B Gerald
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, Asthma & Airway Disease Research Center, 8041University of Arizona, Tucson, AZ, USA
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Dean P, O'Hara K, Brooks L, Shinnar R, Bougher G, Santilli N. Managing Acute Seizures: New Rescue Delivery Option and Resources to Assist School Nurses. NASN Sch Nurse 2021; 36:346-354. [PMID: 34189971 PMCID: PMC8586177 DOI: 10.1177/1942602x211026333] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approximately 470,000 children and adolescents in the United States have epilepsy, 30% of whom experience seizures despite antiseizure drug regimens. School nurses, teachers, caregivers, and parents play integral roles in implementing a care plan that avoids triggers, recognizes signs, and provides supportive care—ideally, guided by a patient-specific seizure action plan, which may include the use of rescue medication. Benzodiazepines are the mainstay of seizure rescue medication; for decades, rectally administered diazepam was the only approved rescue medication for seizure clusters outside the hospital setting. However, rectal administration has limitations that could delay treatment (e.g., social acceptability, removal of clothing, positioning). More recently, intranasal midazolam (for patients ≥12 years) and intranasal diazepam (for patients ≥6 years) were approved for this indication. Training and education regarding newer forms of rescue medication should improve confidence in the ability to treat seizures in school with the goal of increasing the safety of students with epilepsy.
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Affiliation(s)
- Patricia Dean
- Epilepsy Program Specialist, Comprehensive Epilepsy Center, Nicklaus Children's Hospital, Miami, FL
| | - Kathryn O'Hara
- Clinical Research Nurse, Department of Neurology, Virginia Commonwealth University, Richmond, VA
| | - Lai Brooks
- Senior Director of the Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN
| | | | - Genei Bougher
- Vice President/Subinvestigator, Northwest Florida Clinical Research Group, LLC, Gulf Breeze, FL
| | - Nancy Santilli
- Global Managing Director, Human Care Systems, Boston, MA
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Gidal B, Klein P, Hirsch LJ. Seizure clusters, rescue treatments, seizure action plans: Unmet needs and emerging formulations. Epilepsy Behav 2020; 112:107391. [PMID: 32898744 DOI: 10.1016/j.yebeh.2020.107391] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The aim of the study was to provide an overview of the prevalence, risk factors, burden, and current and emerging pharmacologic treatments for seizure clusters in patients with epilepsy. RECENT FINDINGS Close to half of patients with active epilepsy experience seizure clusters, and the clinical, social, and financial burdens of seizure clusters are high. However, there is no widely accepted definition of seizure clusters; their prevalence is underappreciated, contingencies for addressing them (seizure action plans) are often lacking, and their effects are not well-studied. These issues have resulted in an insufficient number of investigations and approved medications for this condition. Novel formulations are in late-stage development to meet this unmet need.
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Affiliation(s)
- Barry Gidal
- University of Wisconsin-Madison, School of Pharmacy, Madison, WI, USA.
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
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