Cluster seizures are episodes of increased seizure activity in which two or more seizures occur in 24 hours. Multiple seizures occur one after the other typically with a recovery period between each seizure and are different from a person’s usual seizure pattern.
Cluster seizures affect people with epilepsy regardless of their sex or age. They may occur rarely or frequently. They may occur in children and adults over the age of 60 years old who have new-onset seizures. If cluster seizures are left untreated, they may progress to status epilepticus, a life-threatening emergency. Status epilepticus is a serious condition in which a single seizure lasts more than five minutes or more than one seizure occurs within five minutes without allowing the person to recover from the first seizure.
Cluster seizures are also known by other terms, all of which describe the condition, characterized by multiple seizures, such as
- Acute repetitive seizures
- Serial seizures
- Crescendo seizures
- Seizure flurries
- Recurrent seizures
- Cyclical seizures
- Seizure clusters
What causes cluster seizures?
The exact reason why cluster seizures occur is not known but they may be associated with a failure of inhibition of the epileptic discharge in the brain.
Some risk factors for cluster seizures include having:
- Frontal lobe epilepsy
- Head injury or trauma
- Poor seizure control
- Focal onset seizures
- Generalized epilepsy
- Rare seizures
- History of central nervous system infection
- Cortical dysplasia
- Complex partial seizure
- Earlier age of seizure onset
- Refractory epilepsy: Failure of more than two seizure medications. A person gets seizures even after trying two or more seizure medications.
- Intractability: Less than one year of seizure freedom
What triggers cluster seizures?
Certain conditions can trigger cluster seizures, including
- Sleep deprivation
- Stress
- Illness
- Fever
- Menstrual period
- Skipping epilepsy medication
- Using alcohol or recreational drugs
In about 30 percent of people who get cluster seizures, there are no identifiable triggers that cause them.
What are the complications of cluster seizures?
Cluster seizures may happen without warning. Without the right treatment, cluster seizures might lead to serious problems such as
- Status epilepticus: This refers to longer seizures or a seizure lasting longer than five minutes. The risk of brain injury goes up if a seizure lasts more than 30 minutes and can become a life-threatening seizure emergency.
- Mental illness: A patient is likely to lose touch with reality (psychosis) after cluster seizures.
- Death: People who have cluster seizures have higher death rates.
- Drowning .
- Car accidents.
- Injuries such as scrapes, cuts or broken bones.
- Pregnancy complications may arise.
- Hospitalization.
- Psychological problems.
- There could be a disruption of school, work, family and social life.
As cluster seizures can cause great harm, it is important to manage them.
How are cluster seizures treated?
Cluster seizures can often be easily treated outside of a hospital. Early treatment may consist of the use of rescue medication that will prevent the need for hospital treatment. Rescue medication has to be given as soon as possible to stop or prevent cluster seizures.
Benzodiazepines are used as rescue treatment to help avert cluster seizures. They stop seizures by changing the levels of a chemical messenger in the brain, called gamma aminobutyric acid (GABA). Side effects of benzodiazepines may include drowsiness and dizziness.
Rescue medication is prescribed along with the patient’s anti-epileptic drug (AED) regimen. AEDs are to be taken every day as prescribed by the doctor to manage seizures. Rescue medication is administered only when cluster seizures occur.
However, if rescue treatments don’t work and seizures continue to occur or complications occur, emergency medical treatment and hospitalization may be required.
Route of administration of rescue medication
Rescue medication can be administered in several ways and necessitates training on how and when to use them to avoid injury or harm to a patient.
- Nasal: Rescue medication is sprayed into the nose to stop cluster seizures. They work quickly and are easy to use.
- Rectal: A gel form of rescue medication is injected into the rectum using a syringe without a needle. This type may be safer, especially for children, during a seizure.
- Cheek: Also called the buccal method. For this method, the rescue medication is put inside the cheek. It is not suitable for people who produce a lot of saliva during a seizure.
- Oral: The medications are taken by mouth as a pill, liquid or wafer.
- Intravenous (IV) or shot: The doctor may give rescue medication through an IV or inject it into a muscle to help stop cluster seizures immediately.
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