Outpatient management of prolonged seizures and seizure clusters to prevent progression to a higher-level emergency: Consensus recommendations of an expert working group

Jesus Eric Pina-Garza¹, Michael Chez², James Cloyd³, Lawrence J Hirsch⁴, Reetta Kälviäinen⁵, Pavel Klein⁶, Lieven Lagae⁷, Raman Sankar⁸, Nicola Specchio⁹, Adam Strzelczyk¹⁰, Manuel Toledo¹¹, Eugen Trinka^{12

13

14

15}

Affiliations

¹ The Children's Hospital at TriStar Centennial, Nashville, Tennessee, USA.
² Sutter Neuroscience Institute, Sacramento, California, USA.
³ College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA.
⁴ Comprehensive Epilepsy Center, Department of Neurology, Yale University, New Haven, Connecticut, USA.
⁵ University of Eastern Finland and Epilepsy Center Kuopio University Hospital, Member of the European Reference Network EpiCARE, Kuopio, Finland.
⁶ Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland, USA.
⁷ Department Development and Regeneration, Section Paediatric Neurology, Full Member of the European Reference Network EpiCARE, University Hospitals Leuven, Leuven, Belgium.
⁸ David Geffen School of Medicine, University of California, Los Angeles, California, USA.
⁹ Neurology, Epilepsy and Movement Disorders Unit, Full Member of the European Reference Network EpiCARE, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹⁰ Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt, Germany.
¹¹ Epilepsy Unit, Neurology Department, Vall d' Hebron University Hospital, Barcelona, Spain.
¹² Department of Neurology, Neurocritical Care and Neurorehabilitation, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University, Salzburg, Austria.
¹³ Neuroscience Institute, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience Salzburg Paracelsus Medical University, Salzburg, Austria.
¹⁴ Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria.
¹⁵ Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.

PMID: 38813941
DOI: 10.1002/epd2.20243

Outpatient management of prolonged seizures and seizure clusters to prevent progression to a higher-level emergency: Consensus recommendations of an expert working group

Jesus Eric Pina-Garza et al. Epileptic Disord. 2024 Aug.

. 2024 Aug;26(4):484-497.

doi: 10.1002/epd2.20243. Epub 2024 May 30.

Authors

Affiliations

¹ The Children's Hospital at TriStar Centennial, Nashville, Tennessee, USA.
² Sutter Neuroscience Institute, Sacramento, California, USA.
³ College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA.
⁴ Comprehensive Epilepsy Center, Department of Neurology, Yale University, New Haven, Connecticut, USA.
⁵ University of Eastern Finland and Epilepsy Center Kuopio University Hospital, Member of the European Reference Network EpiCARE, Kuopio, Finland.
⁶ Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland, USA.
⁷ Department Development and Regeneration, Section Paediatric Neurology, Full Member of the European Reference Network EpiCARE, University Hospitals Leuven, Leuven, Belgium.
⁸ David Geffen School of Medicine, University of California, Los Angeles, California, USA.
⁹ Neurology, Epilepsy and Movement Disorders Unit, Full Member of the European Reference Network EpiCARE, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹⁰ Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt, Germany.
¹¹ Epilepsy Unit, Neurology Department, Vall d' Hebron University Hospital, Barcelona, Spain.
¹² Department of Neurology, Neurocritical Care and Neurorehabilitation, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University, Salzburg, Austria.
¹³ Neuroscience Institute, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience Salzburg Paracelsus Medical University, Salzburg, Austria.
¹⁴ Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria.
¹⁵ Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.

PMID: 38813941
DOI: 10.1002/epd2.20243

Abstract

Objective: The management of prolonged seizures (PS) and seizure clusters (SC) is impeded by the lack of international, evidence-based guidance. We aimed to develop expert recommendations regarding consensus definitions of PS, SC, and treatment goals to prevent progression to higher-level emergencies such as status epilepticus (SE).

Methods: An expert working group, comprising 12 epileptologists, neurologists, and pharmacologists from Europe and North America, used a modified Delphi consensus methodology to develop and anonymously vote on statements. Consensus was defined as ≥75% voting "Agree"/"Strongly agree."

Results: All group members strongly agreed that termination of an ongoing seizure in as short a time as possible is the primary goal of rapid and early seizure termination (REST) and that an ideal medication for REST would start to act within 2 min of administration to terminate ongoing seizure activity. Consensus was reached on the terminology defining PS (with proposed thresholds of 5 min for prolonged focal seizures and 2 min for prolonged absence seizures and the convulsive phase of bilateral tonic-clonic seizures) and SC (an abnormal increase in seizure frequency compared with the individual patient's usual seizure pattern). All group members strongly agreed or agreed that patients who have experienced a PS should be offered a REST medication, and all patients who have experienced a SC should be offered an acute cluster treatment (ACT). Further, when prescribing a REST medication or ACT, a seizure action plan should be agreed upon in consultation with the patient and caregiver.

Significance: The expert working group had a high level of agreement on the recommendations for defining and managing PS and SC. These recommendations will complement the existing guidance for the management of acute seizures, with the possibility of treating them earlier to potentially avoid progression to more severe seizures, including SE.

Keywords: epilepsy; recommendations; seizure duration; terminology.

PubMed Disclaimer

References

REFERENCES

1. Chen Z, Brodie MJ, Liew D, Kwan P. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: a 30‐year longitudinal cohort study. JAMA Neurol. 2018;75(3):279–286.
1. Laxer KD, Trinka E, Hirsch LJ, Cendes F, Langfitt J, Delanty N, et al. The consequences of refractory epilepsy and its treatment. Epilepsy Behav. 2014;37:59–70.
1. Asnis‐Alibozek A, Detyniecki K. The unmet need for rapid epileptic seizure termination (REST). Epilepsy Behav Rep. 2021;15:100409.
1. Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus – report of theILAETask force on classification of status epilepticus. Epilepsia. 2015;56(10):1515–1523.
1. Blond BN, Hirsch LJ. Updated review of rescue treatments for seizure clusters and prolonged seizures. Expert Rev Neurother. 2022;22(7):567–577.

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

Grants and funding

UCB Pharma

LinkOut - more resources

Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Outpatient management of prolonged seizures and seizure clusters to prevent progression to a higher-level emergency: Consensus recommendations of an expert working group

Affiliations

Outpatient management of prolonged seizures and seizure clusters to prevent progression to a higher-level emergency: Consensus recommendations of an expert working group

Authors

Affiliations

Abstract

References

REFERENCES

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Medical