Designing practical evidence-based treatment plans for children with prolonged seizures and status epilepticus

Abstract

The adverse effects of prolonged seizures and status epilepticus can be reduced through appropriate, prompt, and aggressive intervention. Because most prolonged seizures and status epilepticus episodes begin outside the hospital, it is important to design treatment interventions that can be rendered at home or in school that do not rely entirely on intervention by emergency medical personnel. Factors that make this new approach possible include the use of evidence-based guidelines to inform treatment decisions and the successful development, and government approval, of new formulations of commonly used medications, including rectal diazepam gel and the phenytoin prodrug fosphenytoin. A useful plan should be initiated at the 5-minute to 10-minute mark (not the 30-minute mark) and contain clear, easy-to-read directions that can be implemented by family, school personnel, or emergency medical services who have varying levels of medical sophistication. Four scenarios illustrating these considerations are included and provide examples of plans that fulfill these criteria.