Eun Jung Choi, MD, PhD; Senior Director, New Product Launch, Neurology UCB

Seizure Cluster Patients Suffer From More Severe Disease and Lower Remission Rates Interview with:

Eun Jung Choi, MD, PhD; Senior Director, New Product Launch, Neurology UCB

Dr. Eun Jung Choi

Eun Jung Choi, MD, PhD;
Senior Director, New Product Launch, Neurology
UCB What is the background for this study?

Response: Patients experiencing seizure clusters, a type of seizure emergency impacting an estimated 150,000 patients in the U.S. with uncontrolled epilepsy, are at risk for potentially serious consequences including hospitalization, mortality, physical injury, neurological damage, and status epilepticus.

Although unmet needs of seizure clusters are intuitively well accepted, the burden of seizure clusters has not been well characterized and evaluated in a systemic matter. As a result, the seizure cluster patients are overlooked, and burden of seizure clusters is under-recognized. So we systematically assessed the clinical, humanistic, and economic burden associated with seizure clusters to provide the comprehensive body of evidence about burden of seizure clusters. What are the main findings?

Response: Our analysis showed that more severe epilepsy patients (high seizure frequency at baseline, history of status epilepticus, failure of two or more antiepileptic drugs, and prior history of clusters) was associated with seizure clusters. The incidence of status epilepticus in seizure cluster patients was higher than in non-seizure cluster patients with odds ratio of risk ranged from 1.8 to 3.0. Additionally, remission rate of epilepsy was lower in patients with seizure clusters than without seizure clusters.

As suspected, we found the overall quality of life in seizure cluster patients was lower than in seizure-free epilepsy patients on several dimensions:

  • Seizure clusters negatively affected patients’ ability to drive (73% of patients), independence (67%), and travel (59%). Patients’ seizure clusters adversely affected their caregivers in mood (55% of caregivers), travel (52%), vacation (52%), and productivity (48%).
  • Seizure clusters adversely affected patients’ productivity (69%); most of these patients had experienced a seizure at work (62%), or stopped working for some time (53%) due to seizure clusters.

Additionally, about 30% of seizure cluster patients used an emergency room over 1 year. Seizure-related hospitalization was more common in seizure clusters compared to non-seizure cluster patients (odds ratio 5.3). What should readers take away from your report? 

Response:  Results of this analysis suggest that patients with seizure clusters are associated with more severe epilepsy and have a high risk of status epilepticus and poor quality of life. Therefore, physicians should actively identify seizure cluster patients among uncontrolled epilepsy patients to address these high unmet needs. Additionally, while the data on humanistic and economic burden are limited in this under-studied population, it is clear that seizure clusters not only affect the quality of life of both patients and caregivers, but they can also significantly impact their work productivity, and cost of care.

We hope that our analysis brings a great attention to physicians to identify high risk of seizure cluster patients and develop an acute treatment plan with new therapy to address the burdens of the condition, help them terminate seizure clusters and return to living their best lives, such as the recently approved midazolam nasal spray, the first and only nasal option approved by the FDA to treat seizure clusters in more than 20 years in the U.S. The newly available treatment is indicated for the acute treatment of intermittent, stereotypic episodes of frequent seizure activity (i.e., seizure clusters, acute repetitive seizures) that are distinct from a patient’s usual seizure pattern in patients with epilepsy 12 years of age and older. Please see full Prescribing Information, including boxed warning. Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death.

The ready-to-use solution that is designed for seizure emergency gives new hope to patients with seizure clusters who go untreated because of limited treatment options. What recommendations do you have for future research as a result of this work?

Response: With a new treatment option for seizure clusters, there is a great research opportunity to understand how early intervention of seizure clusters could improve clinical, humanistic, and economic outcome and burden as we evaluated in this research.

Disclosures: This was a UCB, Inc. sponsored study.

The results of this systematic literature review are based on data already available in the scientific literature. 

Citation: 2019 American Epilepsy Society Meeting abstract

A systematic review of the clinical, humanistic and economic burden of seizure clusters,
Eun Jung Choi, MD, PhD; Steve S Chung, MD; J Claire Wilson, PhD; Saifuddin Kharawala, DPM, MBBS; Gavneet Kaur, MPharm


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Last Updated on December 19, 2019 by Marie Benz MD FAAD