Acute Drug Administration in Epilepsy: A Review

Abstract

To review acute administration of drugs in epilepsy for indications other than status epilepticus. This review looks into the application of acute drug administration (ADA) against febrile and prolonged nonfebrile seizures in children, seizure clustering (habitual or at drug withdrawal), catamenial epilepsy, response to seizure "warnings", and prophylaxis of seizures at perceived increased risk (reflex epilepsies, long-distance travel, lifestyle, and social occasions). The drugs most commonly used for ADA are the benzodiazepines diazepam (oral or rectal), clobazam and buccal or nasal midazolam, and lorazepam. Others include valproic acid, nitrazepam, acetazolamide, chloral hydrate, pyridoxine, and antipyretics. The best evidence for the efficacy of ADA exists in febrile and nonfebrile childhood seizures, whereas the evidence in catamenial epilepsy is weak. Prevention of clusters is a well-proven principle but its application has been little studied. Prevention of imminent seizures predicted by well-established triggers, defined risk factors, or premonitory minor seizure activity seems to be at the same time the most intelligent and the least investigated application of ADA and would deserve to be better studied.