Seizure Rescue Therapies
Talk with your healthcare provider about your seizure action plan and whether you need a rescue medicine.
What are "as needed" or rescue medicines?
"As needed" medicines are only given in specific situations. Some people also call them "rescue treatments."
- The ideal rescue medicine (1) is easy to use, (2) works quickly, (3) is safe with little to no side effects, and (4) works well.
- The goal is to stop seizures quickly to prevent emergency situations. Hopefully this will prevent you from needing an emergency room. However, rescue medicines do NOT take the place of emergency medical care. If a true medical emergency happens, get emergency medical help right away.
- If medications are prescribed as rescue treatments, they do NOT take the place of daily seizure medications. Most people who have epilepsy are prescribed other medications that they take on a regular basis.
- People who have certain implanted devices for the treatment of epilepsy (such as a vagus nerve stimulator) can use a magnet to swipe over the device generator at the time of the seizure. This is also a form of rescue treatment.
What types of medicines can be used as a rescue treatment?
The most common type of rescue medicines are from a group of medicines called benzodiazepines. These medications get into the bloodstream quickly, to start working in the brain quickly.
- Benzodiazepines are available in several different forms. Depending on the specific benzodiazepine they can be
- Swallowed in pill form (oral)
- Placed under the tongue to dissolve (sublingual)
- Placed between the cheek and the gum to dissolve (buccal)
- Given via a gel through the anus (rectal)
- Sprayed up the nose (nasal)
- In a hospital setting, other forms of benzodiazepines can be given by an injection directly into the bloodstream vein or injected into a muscle.
- The names of benzodiazepines that are most commonly used as rescue medications include diazepam, lorazepam, clonazepam, and midazolam.
- The availability of these medicines in different forms and how they are used may vary from country to country.
- Also, the brand names of these medications can change depending on the form it is given.
- In the United States, the U.S. Food and Drug Administration (FDA) has approved several medications for out-of-hospital use for the treatment of acute repetitive seizures or clusters.
- Diastat® - a diazepam rectal gel
- Nayzilam® - a midazolam nasal spray
- Valtoco® - a diazepam nasal spray
- Other medications are commonly used for out-of-hospital rescue treatment but have not yet been approved by the FDA.
How do I choose the right rescue treatment for me?
- Choosing whether you need a rescue medication, and which medication to choose, should be done during a discussion with your healthcare provider about a seizure action plan. The action plan should involves more than just a taking medication and include seizure first aid and when emergency help is needed.
- Things to consider when talking to your healthcare provider:
- How fast will it work?
- How will I take it? (mouth, nose, etc…)
- How easy is it to use?
- What are the side effects?
- How much does it cost?
- Some people who remain awake and alert may be able to swallow a pill such as lorazepam or diazepam.
- Other people who are not alert may need to be given a form that can be given under the tongue (sublingual), between the cheek and gum (buccally), or sprayed into a nostril (nasal spray).
- People who are not able to take these forms can use rectal diazepam; however this is most often prescribed for children.
When should I use my rescue medicine?
Since seizure emergencies are not common, some people with epilepsy will not need to use any treatment other than their daily amount of seizure medicine. However, sometimes seizures occur in a different pattern that is more often or more severe. Several names have used to describe these patterns, such as seizure clusters and acute repetitive seizures. Stopping seizures early in these situations is the key to preventing a seizure emergency.
- There is no one-size-fits-all when it comes to rescue medicines. Since each person’s seizures are different, their seizure action plan and rescue medicine plan should be made specifically for them.
- When discussing with your health care provider, you should have a good understanding of your typical pattern of seizures and be able to recognize when seizures are not typical for you.
- As part of being prepared, ask your healthcare provider if "as needed" medicines are right for you and develop a clear plan with your provider about when they should be used.
General situations when rescue medicines may be recommended:
- Seizures occur that are different than your usual type or pattern.
- Seizures last longer than typical events.
- Seizure occur more frequently than usual
- Seizure clusters are different than usual – for example when more occur than normal or in a shorter period of time.
- Seizures occur at high-risk times – for example, during medicine changes or when sick.
Rescue Therapies for Children and Adults
Having a seizure action plan is essential for people living with epilepsy, their families, caregivers, classmates, and colleagues. A good seizure action plan includes information about what to do in the event of a seizure emergency. Watch the video for a discussion with Dr. Lawrence Hirsch and Registered Nurse Nancy Santilli about the latest options in rescue therapies for children and adults.
Webinar recorded on September 1, 2022
- Understanding Seizures and Emergencies
- Responding to Seizures
- FDA News: Nayzilam (midazolam) Nasal Spray Approved for Seizure Clusters
- FDA News: Valtoco (diazepam) Nasal Spray Approved as Rescue Therapy for Seizures
- Innovations for Rescue Medications
- Six Questions to Help Decide Whether Your Child Should Have Acute Rescue Medications for Breakthrough Seizures
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