Seizure clusters, a severe form of epilepsy requiring urgent intervention, are challenging to manage in out-of-hospital settings due to limitations of traditional benzodiazepine administration routes. Diazepam nasal spray (DZP-NS), a novel intranasal formulation, achieves rapid absorption through the nasal mucosa, bypassing first-pass metabolism, with bioavailability comparable to rectal gel and faster onset. Clinical studies demonstrate its high efficacy in treating seizure clusters and prolonged seizures (≥5 minutes), with an initial control rate of 87.4% and low second-dose utilization (12.6%). No severe adverse reactions, such as cardiorespiratory depression, were observed. Long-term use (12 months) showed no tolerance development, significantly extending seizure intervals (SEIVAL) (from 12.2 to 25.7 days) and improving quality of life scores, particularly in "epilepsy-related concerns" and "social functioning" domains. The non-invasive delivery method was favored by over 80% of patients and healthcare providers for its convenience compared to rectal administration. Subgroup analyses confirmed consistent safety and efficacy across genders, ages, concomitant medications (including cannabidiol), and patients with allergy histories. In conclusion, DZP-NS provides an efficient, safe, and socially accepted out-of-hospital rescue therapy for seizure clusters, positioning it as a potential cornerstone in standardized epilepsy emergency care.
Objective To explore the clinical value of Persyst automatic detection of spike waves in adult patients with temporal lobe epilepsy. Methods EEG recordings were continuously concluded from the Epilepsy Unit of the First Affiliated Hospital of Soochow University during 2019.1.1 to 2019.12.31. Two EEG experts certified by the Chinese Anti-Epileptic Association marked interictal epileptic discharge in the long-time electroencephalogram that meet the criteria. Consistent results of the two experts were seen as the "golden standard". The sensitivity and false positive rates were calculated compared with the automatic test results of Persyst version 11, 13 and 14. Results 7 cases were included, each with a recording time of 24~25 hours and a total of 169 hours. Two expert readers achieved the consistency of 43.09%. Spike waves detected automatically were much more than manually. The sensitivity was as high as 62.26%, 77.0% and 67.28%. The lowest false positive rate was 0.37/min, 0.85/min and 0.46/min respectively. Automatic analysis achieved an average workload reduction of 14.59%~37.05%. Conclusions Persyst automatic spike detection has the acceptable sensitivity and false positive rate. It differs from versions and need to be further combined with expert readers.Less workload and accuracy can be balanced by setting reasonable perception parameter.