Predictors for and use of rescue medication in adults with epilepsy: A multicentre cross-sectional study from Germany

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 or cluster seizures an individual rescue treatment with instructions on using it may decrease mortality and morbidity and increase quality of life. .