Acute Repetitive Seizures from Pathophysiology to Novel Treatment Options

Acute recurrent seizures, also known as ARS, represent a significant challenge in epilepsy management, especially in those with drug-resistant epilepsy. These seizures are associated with higher morbidity and mortality rates, as well as hospitalization, with sudden, recurring episodes that veer out of a patient's typical seizure pattern. Neuronal hyperexcitability, synaptic remodeling, and neurotransmitter imbalances are just a few of the myriad processes underlying the pathophysiology of ARS, which is influenced by both hereditary and environmental factors. Current therapies, dominated by the use of benzodiazepines such as midazolam and diazepam, have shown promise but have drawbacks that include delayed dosing, low absorption, and practical difficulties during acute episodes. These disadvantages underscore the need for novel strategies. New therapeutic approaches, such as intranasal benzodiazepines, have promised rapid, noninvasive rescue therapy with improved patient compliance. Herbal and natural substances are increasingly under investigation as potential adjunctive medications, leveraging their myriad bioactive components to address underlying systems such as immune modulation, oxidative stress reduction, and regulating ion channels. The holistic nature of herbal treatments may contribute to a reduction in psychological burden on patients and caregivers, an important component of the management of ARS. This article presents a narrative review of the existing literature, integrating findings from clinical and preclinical studies to provide a comprehensive overview of acute repetitive seizures and their management. It points out a future of integrative approaches that might combine traditional and alternative therapies to further enhance outcomes and quality of life for individuals with ARS.