• A person can use seizure rescue treatments in addition to their regular antiepileptic drugs (AEDs) to limit or stop seizures.
• Rescue treatment options include medications that can be taken by mouth, as a nasal spray, or rectally, as well as implantable vagus nerve stimulation (VNS) devices.
• Each seizure rescue therapy comes with pros and cons. A person needs to weigh them with their doctor to decide on the best option.

Seizure rescue treatments are used separately from a person’s daily anti-seizure drug routine. Instead of taking the place of antiepileptic drugs, these medications and devices typically work alongside those AEDs to limit or stop seizures that do any of the following:

• Occur more often than usual
• Last for longer periods of time
• Become stronger in their severity
• Happen in groups within a matter of hours or days (seizure clusters)

Rescue medication works best when taken only as needed, during a seizure event. In this way, rescue therapy can stop seizures and keep a seizure emergency from happening.

A person with epilepsy may be able to use different types of rescue treatments. It is important, however, to find the best form that works for each individual.

Types of Seizure Rescue Medications

Depending on the individual, a person with epilepsy may take a seizure rescue medication in the following forms:

• Pills that can be swallowed or put under the tongue or in the cheek to dissolve
• Nasal spray that goes up a person’s nose
• Rectal gel administered through the rectum

Seizure rescue medicines are often from a class of drugs called benzodiazepines, which includes diazepam and midazolam. This type of medication gets into the bloodstream quickly, then rapidly takes effect in the brain. It works by calming the brain during a seizure and slowing its electrical activity. As brain function slows down from the medication, the seizure activity decreases.

Although rescue medications help to calm a hyperactive brain in the middle of a seizure, the drugs mentioned above each take a different pathway to get to the brain. These pathways play a role in how quickly each type of rescue medication will work.

Oral Route

Oral seizure rescue medications can quickly get the medicine to the brain so it can begin taking effect. Some can take 15 to 30 minutes to begin to work; others can take effect more quickly.

Clonazepam (Klonopin), for example, is available as a pill or a quickly dissolving tablet. Many health care professionals prescribe this type of rescue medicine for long-lasting seizures because of its speed and effectiveness. One study found that, for around 70 percent of people, dissolving oral clonazepam wafers could halt a seizure in less than 10 minutes about half of the time. For some participants, the drug could stop seizures within one minute about half the time.

One MyEpilepsyTeam member reported how successful clonazepam has been for them. They said, “I put a tablet of clonazepam under my tongue to dissolve. It very quickly stops the seizures.”

Nasal Route

When a person with epilepsy takes a nasal form of rescue medicine, the medication enters their bloodstream and brain quickly. These drugs take effect faster than oral medications and may pause a seizure within minutes of inhaling them. They can also last a long time.

The U.S. Food and Drug Administration (FDA) has approved two drugs in this category for treating seizure clusters: a form of midazolam sold as Nayzilam and a form of diazepam sold as Valtoco. According to the Epilepsy Foundation, the effects of Nayzilam may last up to six hours, and Valtoco may remain effective for up to two days.

One MyEpilepsyTeam member commented, “We use Valtoco, another kind of nasal rescue medicine. It works fabulously and stops the seizure in its tracks!”

One research study found that midazolam nasal spray stopped a seizure cluster in less than 10 minutes in about half of all people over 11 years old. In addition, those seizures did not return for about six hours.

Rectal Route

When given via the rectum, a rescue medicine absorbs quickly into the bloodstream. Diastat AcuDial is an FDA-approved benzodiazepine rectal gel formulation of diazepam. This type of rectal gel may stop a seizure within 15 minutes. It’s approved for people 2 years and older who experience long-lasting seizures — provided they are also taking regular daily seizure medication. The effect of the medication can last for almost two days.

A clinical study showed diazepam rectal gel was effective at stopping seizures: Sixty-two percent of people in the study remained free of seizures for 12 to 24 hours after taking the medicine.

Implantable Device for Seizure Rescue Therapy

People with epilepsy may have an alternative treatment to medication: having a vagus nerve stimulation (VNS) device implanted in their chest. The goal of vagus nerve stimulation is to decrease the length of time, the number, and the severity of a person’s seizures. This device acts as a seizure rescue therapy when needed.

The implant surgery connects the device to the vagus nerve, which runs between the brain and the rest of the body via the neck. When stimulated with electricity from the apparatus, the vagus nerve sends signals to the brain that can help decrease seizure activity.

Normally, the VNS device gives an electrical pulse through the vagus nerve to the brain for approximately 30 seconds every five minutes; the rate can vary from person to person. When someone gets a seizure and needs a stronger VNS signal, they can swipe a magnet over the stimulator to increase the intensity. If a person’s seizure is severe enough, their caregiver can move the magnet over their chest. Other VNS devices increase intensity by sensing a person’s heart rate rise during a seizure.

Concerning VNS, one MyEpilepsyTeam member commented, “My child has had a vagus nerve stimulator for over seven years because of their drop seizures. We swipe them, and the seizures stop.”

Research shows that VNS decreases people’s seizure activity by 50 percent or more in about half of the people studied. To get this level of benefit, research shows that people usually need to use their VNS device for at least one year.

Which Seizure Rescue Therapy Is Right for You?

It’s important to know the pros and cons of each seizure rescue therapy. This allows a person to make an informed decision — along with their doctor — about which therapy is best for them.

If a person is concerned about any of the downsides to a form of rescue treatment, they should discuss other options for seizure rescue medicine with their doctor.

Here are the pros and cons of each type of rescue therapy.

Oral Route

Oral rescue medications come with the following benefits:

• They’re fast-acting.
• They can be taken easily by mouth.
• They offer a socially appealing way to take medicine.
• They work for long-lasting seizures.

The drawbacks of oral rescue medications include the following:

• They’re not suitable for young children who cannot swallow.
• They’re difficult to take for a sleepy or less-alert person.
• They’re not a good fit for someone with an excessive amount of seizures.
• Their side effects include tiredness, headache, weakness, and memory loss.

Nasal Route

Taking a rescue therapy as a nasal spray comes with the following benefits:

• These medications are a good alternative for someone who cannot take medicine by mouth.
• They work faster than oral medications.
• They’re suitable for someone with cluster seizures.
• They stay in the bloodstream for a longer period of time.

The nasal form of seizure rescue medications carries the following cons:

• They can lead to sleepiness.
• They can cause discomfort inside someone’s nose.
• They require training to administer to someone else.
• Their side effects include headache, slurred speech, throat discomfort, nose bleeds, and runny nose.

Rectal Route

The rectal form of seizure rescue medicines carry the following benefits:

• Someone without a medical background can administer these medications outside of a hospital setting.
• They’re suitable alternatives for someone who cannot take medication by mouth.
• They work well for long-lasting seizures.
• They take effect quickly.
• They remain in a person’s system for almost two days.

The drawbacks of taking a seizure rescue therapy rectally include the following:

• They’re difficult to administer in public because they require undressing.
• They may not be suitable for pregnant people, elderly people, or those with breathing conditions.
• They may not mix well with opioids.
• Their side effects include grogginess, headache, dizziness, and diarrhea.

Vagus Nerve Stimulation Devices

VNS devices as a form of rescue therapy for seizures carry the following benefits:

• Much of the therapy is automatic and requires no effort.
• They’re an effective form of seizure control.
• When needed, increasing the devices’ intensity is simple — and sometimes automated.
• They may also improve a person’s alertness, memory, or mood.

VNS devices carry the following cons:

• They require a surgical procedure.
• They may take up to two years before they are effective.
• Side effects include trouble swallowing, hoarseness, coughing, or throat discomfort.
• They may impact a person’s ability to have an MRI scan.
• They require a person to carry a therapy card when passing through airport security.

Talk With Others Who Understand

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