Intranasal delivery of antiseizure drugs

Abstract Acute repetitive or long-lasting epileptic seizures require pharmacological treatment, which is usually administered intravenously by certified personnel, consisting of antiseizure drugs such as benzodiazepines. In epileptic patients, these seizures will likely occur in a nonhospital setting and will require assistance by a caretaker, or self-administration of antiseizure drugs during the period in between seizures, before medical support can be provided. Noninvasive alternative routes of administration have been explored over the years, leading to the approval of rectal diazepam and buccal midazolam preparations. More recently, a midazolam nasal spray has been approved in 2019 for acute treatment of seizure clusters (repetitive seizures) in the community. This is an example of a long research history with a successful outcome regarding the development of intranasal antiseizure therapy. This chapter describes epileptic seizures and epilepsy, their current treatment, and some aspects of the vast research involving the development of antiseizure medicines for intranasal administration, aiming to explore the advantages and potential of intranasal drug delivery for brain targeting.