Proportions of seizure episodes requiring a second dose of rescue medication and the impact those second doses had on healthcare utilization are reported.

Seizure clusters may last up to 24 hours. Approved outpatient rescue therapies have differing profiles that may affect multiple aspects of healthcare utilization.

For 3 large, long-term studies of approved seizure-cluster treatments (ie, rectal diazepam, intranasal midazolam, diazepam nasal spray), percentage of episodes controlled by the initial dose was compared with those requiring a second dose before 6 or 12 hours. Hospitalization data after second doses were collected.

For rectal diazepam seizure control ≤12 hours after treatment, 77% of administrations (1215/1578) prevented further seizures (second doses not reported). For intranasal midazolam, measuring seizure control 10 minutes to 6 hours after treatment, 55.5% (1108/1998) of seizure-cluster episodes were successfully treated; second doses were not administered in 61.4% of seizure episodes (1226/1998). For diazepam nasal spray, no second dose was administered in 94.5% (3829/4053) of seizure episodes within 6 hours of the initial dose and 92.2% (3735/4053) within 12 hours.

For diazepam rectal gel, 16 of 363 seizure clusters were subsequently treated in the emergency department. For intranasal midazolam, 4 patients had 1 serious adverse event (SAE) possibly treatment related (association with second dose not reported). For diazepam nasal spray, no SAEs were considered treatment related; 3 SAEs occurred the day of/day after a second dose. None required a dose change; all resolved.