LAUSR

Seizure clusters are a serious, yet often underdiagnosed and inadequately treated, occurrence in people with epilepsy. A challenge for both health care providers and patients is the lack of a cohesive integrated body of information examining the definitions, causes, consequences, and therapies for seizure clusters. This supplement aims to provide a practical resource about seizure clusters for both caregivers and people with epilepsy. To create a comprehensive informative view of this serious condition, this supplement integrates fundamental, translational, and clinical trial data with family insights, expert practical experience, and pharmacoeconomic approaches. Through this series of articles, the reader will be both more informed and more empowered to create, implement, and execute effective acute seizure action plans (ASAPs) that will likely reduce the serious medical and qualityoflife consequences associated with seizure clusters. This knowledge will enable the health care provider to communicate with and listen to patients and caregivers more effectively when discussing seizure control and safety. The first article by Haut and Nabbout directly addresses the fundamental challenge that there is no universally agreedupon definition for “seizure cluster,” either in clinical trials or in clinical practice. As such, reported prevalence of seizure clusters varies widely (13%– 76%) among people with epilepsy, but these percentages indicate that this problem is clearly not a minor health issue. The various definitions used in clinical trials are reviewed, along with several clinical vignettes that illustrate the different descriptions seen in seizure clusters. However, the authors point out that the lack of a classical standardized definition using seizure number and time periods allows the caregiver and patient to design a customized and individualized definition that can facilitate communication and care. Next, Kapur, Long, and DixonSalazar examine the consequences of seizure clusters from multiple viewpoints: the molecular perspective of its pathophysiologic underlying mechanisms, the caregiver role in early identification and treatment, and finally the patient and family's view and approach to these alarming and anxietyprovoking events. Individual seizures are typically selflimited due to coordinated actions at multiple brain levels (circuit, cellular, and molecular). The recurrent seizures that define seizure clusters disrupt γaminobutyric acidergic (GABAergic) mechanisms while also initiating synaptic potentiation, enhancing the risk for further seizures. This article reviews basic science data supporting the importance of early treatment with benzodiazepines to disrupt the biological consequences of seizure clusters. The authors then address the role of the clinician in helping to reduce the clinical consequences of seizure clusters. By serving as a communicator, educator, and health care provider, the clinician can determine whether seizure clusters are occurring, develop an individualized ASAP, and prescribe the appropriate treatment modalities (e.g., benzodiazepines) for the patient. Finally, the authors point out that to fully minimize the consequences of seizure