Abstract
Characterize the real-world management of and outcomes for children with epilepsy receiving rescue medication for prolonged acute convulsive seizures (PACS) in the community. PERFECT-3 (Practices in Emergency and Rescue medication For Epilepsy managed with Community-administered Therapy 3) was a European, retrospective observational study. Eligible patients were non-institutionalized children with epilepsy aged 3-16 years who had experienced ≥1 PACS in the past year and had ≥1 currently prescribed PACS rescue medication. Investigators provided clinical assessments and parents/guardians completed questionnaires. Statistical tests were post hoc; p values are descriptive. At enrollment (N=286), most patients had prescriptions for diazepam (69.2%) and/or midazolam (55.9%); some had two (26.6%) or three (2.4%) prescribed rescue medications. Most patients experienced PACS despite regular anti-epilepsy medication. According to parents, the average duration of their child's seizures without rescue medication was <5min in 35.7% of patients, 5-<20min in 42.6%, and ≥20min in 21.7% (n=258); withrescue medication seizure duration was <5min in 69.4% of patients, 5-<20min in 25.6%, and ≥20min in 5.0%. Rescue medication use was significantly associated with average seizures lasting <5min (χ2=58.8; p<0.0001). At the time of their most recent PACS, 58.5-67.8% of children reportedly received rescue medication within 5min of seizure onset, and 85.4-94.1% within 10min. This study provides the first real-world data that rescue medications administered in the community reduce the duration of PACS in children with epilepsy. Study limitations including potential recall bias are acknowledged.
Highlights
Most seizures experienced by children with epilepsy stop spontaneously within 5 min, but prolonged seizures lasting longer than 5 min are likely to progress to status epilepticus without treatment.[1]
Despite widespread prescription for community use, there is only sparse evidence that rescue medication administered to children by parents, teachers, or other caregivers reduces seizure duration and prevents status epilepticus
Eligible patients were non-institutionalized children who had been diagnosed with epilepsy at least 12 months previously, had experienced one or more prolonged acute seizures (PACS) in the past 12 months, and had one or more current prescriptions for PACS rescue medication
Summary
Most seizures experienced by children with epilepsy stop spontaneously within 5 min, but prolonged seizures lasting longer than 5 min are likely to progress to status epilepticus without treatment.[1]. Randomized controlled studies have shown that benzodiazepine rescue medications terminate seizures when given in the emergency department[4] or by paramedics.[5] Despite widespread prescription for community use, there is only sparse evidence that rescue medication administered to children by parents, teachers, or other caregivers reduces seizure duration and prevents status epilepticus. Clinical guidelines offer few recommendations regarding whether and when community caregivers should administer rescue medication.[6] The few studies of home use of rescue medication that compared treated and untreated seizures have focused on emergency hospital admissions[7] or the frequency of acute repetitive seizures.[8,9]
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