Expert Consensus on Seizure Treatment in Non-healthcare Settings: Time to Treat
Abstract number :
3.434
Submission category :
7. Anti-seizure Medications / 7E. Other
Year :
2024
Submission ID :
512
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Manuel Toledo, MD, PhD – Vall d'Hebron University Hospital
Mar Carreño, MD, PhD – Hospital Clinic Barcelona
Irene García-Morales, MD, PhD – Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain.
Juan Jose García Peñas, MD – Hospital San Rafael, Madrid
Antonio Gil-Nagel, MD, PhD – Hospital Ruber Internacional
Pedro Serrano, MD PhD – Hospital Regional Universitario Málaga
Jose Serratosa, MD, PhD – Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
Patricia Smeyers Durá, MD, PhD – Hospital Universitario y Politécnico La Fe, Valencia, Spain
Víctor Soto Insuga, PhD – Hospital Universitario Niño Jesus
Vicente Villanueva, MD – Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Presenting Author: Juan Rodríguez Uranga, MD – Centro de Neurología Avanzada
Rationale: Early intervention on prolonged and cluster type seizures can prevent serious consequences such as irreversible neuronal injury, late-onset epileptogenesis, sudden unexpected death, and premature death, among others. Moreover, progression to status epilepticus, with a 20% death rate, may be further prevented. However, prehospital seizure diagnosis and treatment is often delayed, taking patients over 30 minutes from seizure onset to receive treatment. Conversely, most seizures last less than 2 minutes (Larsen et al., 2023). The lack of out-of-hospital seizure management guidelines drives the need to determine the time at which rapid epileptic seizure termination (REST) treatment should be administered in non-healthcare settings.
Methods: Eleven epileptologists reviewed and discussed the scientific literature in face-to-face working meetings, followed by individual work. Recommendations for treating prolonged and cluster seizures in the non-healthcare setting were established.
Results: REST treatment, unless contraindicated, is suitable for all patients with epileptic auras, those at risk of prolonged or cluster seizures (i.e., history status epilepticus, atypical febrile seizures, and patients with refractory epilepsy), or for patients with anti-seizure medication withdrawal. Moreover, REST treatment may be prescribed for prolonged or cluster seizure risk situations such as sleep deprivation, severe emotional stress, or poor medication compliance. REST treatment should be administered at 2 minutes of seizure-onset. However, this should be based on usual seizure duration and frequency for each patient. Regarding prolonged seizures (Figure 1), those with motor symptoms (MS) and generalized tonic-clonic seizures should be treated at 2 minutes of seizure onset. This time may be shortened considering usual seizure frequency and duration. Moreover, prolonged seizures without MS should be treated considering usual seizure duration and progression, regardless of the state of consciousness. Regarding seizure clusters (Figure 2), those with MS, and those without MS and altered consciousness, should be treated if they double their usual frequency in 8 hours. Moreover, generalized tonic-clonic clusters should be treated at the onset of the second seizure occurring within 24 hours. Seizures without MS or altered consciousness should be treated considering usual seizure progression.
Conclusions: Non-healthcare personnel that may administer REST treatment should follow these recommendations. A 2-minute seizure duration or a 2-fold increase in seizure frequency is crucial in most cases.
Funding: This study was funded by UCB Pharma S.A.
Anti-seizure Medications