Treatment Options for Seizure Clusters

Medically Reviewed by Christopher Melinosky, MD on January 16, 2023
3 min read

Seizure clusters happen when you have multiple seizures in a short time period, closer together than is usual for you, and recover between seizures. If you have a cluster of seizures, it's important to try to stop them so you don't end up in the hospital.

Doctors prescribe a class of drugs called benzodiazepines to stop seizure clusters after they start. Benzodiazepines work by changing the level of a chemical messenger in your brain called GABA. Their side effects may include drowsiness and dizziness.

Benzodiazepines are a "rescue" medication. These are different from the anti-seizure medications (ASMs) you may take every day to control your condition.  

If you or a caregiver can tell when a cluster is starting, start a rescue treatment right away. These drugs do not take the place of daily medications and should only be used to help stop a seizure quickly in emergency situations. You can take these medications in several ways. All rescue medications require training on how and when to use them in order to avoid injury or harm.

Rectal. This method is usually used when you're having a seizure. Someone injects a gel form of diazepam (Diastat) into your rectum, using a syringe without a needle.

This can be uncomfortable and embarrassing. But these drugs work much faster than oral rescue medications. Side effects include sleepiness, dizziness, headache, and pain.

Nasal. These medications called diazepam (Valtoco) and midazolam (Nayzilam), are simple options that your body absorbs quickly. Someone sprays them into your nose to stop cluster seizures.

Midazolam works quicker than diazepam, but it doesn't last as long in your body. Side effects of nasal diazepam and midazolam include nasal irritation, fatigue, watery eyes, and an odd taste.

Your doctor can show a caregiver how to use nasal rescue medications so they're ready to help you in case of a seizure. 

You can get the sprays in any position, which makes it easier to get help during a seizure.

In your cheek. A caregiver can also put midazalam in your cheek. This is called the buccal method. Side effects include a bitter taste and risk of aspiration (when the medication gets into your airways or lungs).

This method might not be right for people who tend to vomit or create a lot of saliva during a seizure.

Oral. These are medications you take by mouth, as a pill, liquid, or wafer. They include clonazepam (Klonopin), diazepam, lorazepam (Ativan), and midazalam

Oral treatments take longer to work than some other types. Also, it can be hard to take them while you're having a seizure. So they may not be the best option for quick relief.

With an IV or shot. Your doctor can give you rescue medication through an IV in the hospital or inject it into a muscle to help your seizure clusters right away. A shot is one of the easier methods to use. But your body may not absorb the drug completely, so it might not stop the seizures. You could also have a reaction or injury in the area of the injection.  

Sometimes treatment at home or in your doctor's office isn't enough to stop your cluster seizures. They may keep happening or get worse. In this situation, you or a caregiver should seek medical help right away.

Once you're in a hospital, you can get benzodiazepines through an IV to stop your seizures. This works faster than any other method.

Talk to your doctor about an emergency plan for seizure clusters. This will help you understand how to use rescue treatments, which can mean you need to go to the hospital less often.

If you use AEDs to prevent seizures, it's important to always take them as prescribed. They can't stop a seizure once it starts. But skipping them makes you more likely to have a cluster of seizures in the first place.

These medications change levels of certain chemicals in your brain to help prevent seizures. They work for about 70% of people. You usually take them every day as a pill or liquid.

Some of the more common types include: