Treating acute paediatric seizure clusters warrants considerations of comfort

Paediatric patients with epilepsy are at risk of experiencing an acute increase in seizure frequency, called seizure clusters. These events can lead to life-threatening status epilepticus and can have lasting negative physical and psychosocial effects if treatment is not promptly administered; thus, treatment should be administrable at home or in an outpatient/ambulatory care setting. In the USA, there are three medications approved for this indication: diazepam rectal gel, midazolam nasal spray and diazepam nasal spray. Nasal sprays are the preferred route of administration, offering an easier to use and more socially acceptable alternative to rectal gel treatment. This article reviews the efficacy and safety of these treatments for paediatric patients experiencing seizure clusters, as well as important considerations for treatment choice.