Rescue therapies for seizure emergencies: New modes of administration

Epilepsia
Patricia D MaglalangJames C Cloyd

Abstract

A subgroup of patients with drug-resistant epilepsy have seizure clusters, which are a part of the continuum of seizure emergencies that includes prolonged episodes and status epilepticus. When the patient or caregiver can identify the beginning of a cluster, the condition is amenable to certain treatments, an approach known as rescue therapy. Intravenous drug administration offers the fastest onset of action, but this route is usually not an option because most seizure clusters occur outside of a medical facility. Alternate routes of administration have been used or are proposed including rectal, buccal, intrapulmonary, subcutaneous, intramuscular, and intranasal. The objective of this narrative review is to describe the (1) anatomical, physiologic, and drug physicochemical properties that need to be considered when developing therapies for seizure emergencies and (2) products currently in development. New therapies must consider parameters of Fick's law such as absorptive surface area, blood flow, membrane thickness, and lipid solubility, because these factors affect both rate and extend of absorption. For example, the lung has a 50 000-fold greater absorptive surface area than that associated with a subcutaneous injection. L...Continue Reading

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Citations

Jun 5, 2019·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Abhishek G SatheJames C Cloyd
Jan 23, 2020·Epilepsy Currents·Stephen F TraynelisUNKNOWN National Institutes of Neurological Disorders and Stroke (NINDS)/American Epilepsy Society (AES) Epilepsy Research Benchmark
Jan 10, 2020·Clinical Pharmacology in Drug Development·Sarina TanimotoEnrique Carrazana
Aug 26, 2020·Expert Opinion on Pharmacotherapy·Antonella RivaAlberto Verrotti
Sep 9, 2020·Epilepsy & Behavior : E&B·Barry GidalLawrence J Hirsch
Jan 26, 2021·Epilepsy & Behavior Reports·Aviva Asnis-Alibozek, Kamil Detyniecki
Jun 27, 2021·European Journal of Pharmaceutical Sciences : Official Journal of the European Federation for Pharmaceutical Sciences·Patrícia C PiresAdriana O Santos
Jul 17, 2021·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Debopam Samanta
Aug 11, 2021·Expert Review of Neurotherapeutics·Lindsay M Higdon, Michael R Sperling
Aug 20, 2021·Journal of Drug Assessment·Boulenouar MesraouaAli A Asadi-Pooya
Nov 7, 2020·International Journal of Pharmaceutics·Patrícia C PiresAdriana O Santos

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