The Practical Impact of Seizure Rescue Medication in the Landscape of Epilepsy Care: Kamil Detyniecki, MD

WATCH TIME: 3 minutes

"As we look at the future of seizure rescue treatments, there's many promising areas of potential research. In one key area is population-based studies, which aim to look at the efficiency or efficacy of seizure rescue treatments across different subpopulations and of patients that have not been studied in the previous trials.”

Epilepsy, a common pediatric neurological condition, affects approximately 470,000 pediatric patients in the United States alone and has a prevalence of 0.9% in the global population of approximately 2.6 billion pediatric patients.¹ According to recent research, the condition is often associated with disruptions in several areas of a patient’s life, including medical burden, quality of life, cognitive outcomes, and higher risk of mortality. In addition, some pediatric patients may experience seizure clusters (SCs), which are intermittent increases in seizure activity that are different from the patient's usual seizure pattern and may occur regardless of daily antiseizure medication.

A new post hoc analysis published in the journal of Epilepsy & Behavior on the phase 3 open-label extension study (NCT01529034) assessed midazolam (Nayzilam; UCB), an FDA-approved antiseizure medication, and patient’s ability to return to full baseline functionality (RTFBF) on the treatment.² Results showed that 90 minutes was the estimated median time to RTFBF regardless of 1 or 2 doses in patients at least 12 years old who experienced SCs.2 In 1996 SCs (patients, n = 162) treated with 1 or 2 doses (1 dose, n = 1201 [60.2%]; 2 doses, n = 795 [39.8%]) of midazolam, investigators observed RTFBF within 24 hours of midazolam administration in 97.2% and 94.2% of participants, respectively. At the same time, the estimated median time observed was between 1.2 hours and 1.3 hours, with noted as being stable between 1 and 45 treated SCEs.

Lead author Kamil Detyniecki, MD, associate professor of clinical neurology at University of Miami Miller School of Medicine, recently sat down in an interview with NeurologyLive® to discuss how the lack of tolerance development to seizure rescue medication might impact its long-term effectiveness in patients. He also talked about the key areas of research that are highlighted for the future of seizure rescue treatments, especially in terms of inclusive patient populations and technological integration. Additionally, Detyniecki spoke about how innovations like structural inhalation devices potentially offer a new avenue for faster-acting seizure rescue medications, and what their potential transformation might bring to acute seizure episode management.

REFERENCES
1. Wheless JW, Gidal B, Rabinowicz AL, Carrazana E. Practical Questions About Rescue Medications for Acute Treatment of Seizure Clusters in Children and Adolescents with Epilepsy in the USA: Expanding Treatment Options to Address Unmet Needs. Paediatr Drugs. 2023;10.1007/s40272-023-00601-x. doi:10.1007/s40272-023-00601-x
2. Detyniecki K, Brunnert M, Campos R, Dimova S, Wheless JW. Return to full baseline functionality after repeated intermittent use of midazolam nasal spray in patients with seizure clusters: post hoc analysis of an open-label extension trial. Epilepsy Behav. 2023;148:109435. doi:10.1016/j.yebeh.2023.109483