title: Seizure clusters: characteristics and treatment.
abstract: OBJECTIVE
  Many patients with epilepsy experience 'clusters' or flurries of seizures, also termed acute repetitive seizures (ARS). Seizure clustering has a significant impact on health and quality of life. This review summarizes recent advances in the definition and neurophysiologic understanding of clustering, the epidemiology and risk factors for clustering and both inpatient and outpatient clinical implications. New treatments for seizure clustering/ARS are perhaps the area of greatest recent progress.
  
  
  RESULTS
  Efforts have focused on creating a uniform definition of a seizure cluster. In neurophysiologic studies of refractory epilepsy, seizures within a cluster appear to be self-triggering. Clinical progress has been achieved towards a more precise prevalence of clustering, and consensus guidelines for epilepsy monitoring unit safety. The greatest recent advances are in the study of nonintravenous route of benzodiazepines as rescue medications for seizure clusters/ARS. Rectal benzodiazepines have been very effective but barriers to use exist. New data on buccal, intramuscular and intranasal preparations are anticipated to lead to a greater number of approved treatments. Progesterone may be effective for women who experience catamenial clusters.
  
  
  CONCLUSIONS
  Seizure clustering is common, particularly in the setting of medically refractory epilepsy. Clustering worsens health and quality of life, and the field requires greater focus on clarifying of definition and clinical implications. Progress towards the development of nonintravenous routes of benzodiazepines has the potential to improve care in this area.
authors.affiliation: aMontefiore-Einstein Epilepsy Center bDepartment of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Sheryl R
authors.initials: SR
authors.lastname: Haut
mesh_terms: D000818:Animals; D000927:Anticonvulsants / Q000627:therapeutic use*; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000927:Anticonvulsants