Outpatient management of prolonged seizures and seizure clusters to prevent progression to a higher-level emergency: Consensus recommendations of an expert working group.
epilepsy
recommendations
seizure duration
terminology
Journal
Epileptic disorders : international epilepsy journal with videotape
ISSN: 1950-6945
Titre abrégé: Epileptic Disord
Pays: United States
ID NLM: 100891853
Informations de publication
Date de publication:
30 May 2024
30 May 2024
Historique:
revised:
25
04
2024
received:
15
02
2024
accepted:
03
05
2024
medline:
30
5
2024
pubmed:
30
5
2024
entrez:
30
5
2024
Statut:
aheadofprint
Résumé
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). 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." 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. 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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : UCB Pharma
Informations de copyright
© 2024 The Author(s). Epileptic Disorders published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.
Références
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.
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.
Asnis‐Alibozek A, Detyniecki K. The unmet need for rapid epileptic seizure termination (REST). Epilepsy Behav Rep. 2021;15:100409.
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.
Blond BN, Hirsch LJ. Updated review of rescue treatments for seizure clusters and prolonged seizures. Expert Rev Neurother. 2022;22(7):567–577.
Samanta D. Rescue therapies for seizure emergencies: current and future landscape. Neurol Sci. 2021;42(10):4017–4027.
Kazl C, LaJoie J. Emergency seizure management. Curr Probl Pediatr Adolesc Health Care. 2020;50(11):100892.
Dingledine R, Varvel NH, Dudek FE. When and how do seizures kill neurons, and is cell death relevant to epileptogenesis? Adv Exp Med Biol. 2014;813:109–122.
Der‐Nigoghossian C, Rubinos C, Alkhachroum A, Claassen J. Status epilepticus – time is brain and treatment considerations. Curr Opin Crit Care. 2019;25(6):638–646.
Trinka E, Rainer LJ, Granbichler CA, Zimmermann G, Leitinger M. Mortality, and life expectancy in epilepsy and status epilepticus—current trends and future aspects. Frontiers. Epidemiology. 2023;3:3.
Bosque Varela P, Machegger L, Oellerer A, Steinbacher J, McCoy M, Pfaff J, et al. Imaging of status epilepticus: making the invisible visible. A prospective study on 206 patients. Epilepsy Behav. 2023;141:109130.
Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, et al. Evidence‐based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48–61.
National Institute for Health and Care Excellence (NICE). Epilepsies in children, young people and adults (guideline NG217). 2022. Available from: https://wwwniceorguk/guidance/ng217?UID=273480007202341532127 Accessed Apr 2023
Chung S, Szaflarski JP, Choi EJ, Wilson JC, Kharawala S, Kaur G, et al. A systematic review of seizure clusters: prevalence, risk factors, burden of disease and treatment patterns. Epilepsy Res. 2021;177:106748.
Detyniecki K, O'Bryan J, Choezom T, Rak G, Ma C, Zhang S, et al. Prevalence and predictors of seizure clusters: a prospective observational study of adult patients with epilepsy. Epilepsy Behav. 2018;88:349–356.
Jafarpour S, Hirsch LJ, Gaínza‐Lein M, Kellinghaus C, Detyniecki K. Seizure cluster: definition, prevalence, consequences, and management. Seizure. 2019;68:9–15.
Buchhalter J, Shafer PO, Buelow JM, French JA, Gilchrist B, Hirsch LJ, et al. Preferred practices for rescue treatment of seizure clusters: a consensus‐driven, multi‐stakeholder approach. Epilepsy Behav. 2021;117:107836.
Komaragiri A, Detyniecki K, Hirsch LJ. Seizure clusters: a common, understudied and undertreated phenomenon in refractory epilepsy. Epilepsy Behav. 2016;59:83–86.
Barcia Aguilar C, Amengual‐Gual M, Sánchez Fernández I, Abend NS, Anderson A, Appavu B, et al. Time to treatment in pediatric convulsive refractory status epilepticus: the weekend effect. Pediatr Neurol. 2021;120:71–79.
Dobesberger J, Ristić AJ, Walser G, Kuchukhidze G, Unterberger I, Höfler J, et al. Duration of focal complex, secondarily generalized tonic–clonic, and primarily generalized tonic–clonic seizures — a video‐EEG analysis. Epilepsy Behav. 2015;49:111–117.
Sathe AG, Underwood E, Coles LD, Elm JJ, Silbergleit R, Chamberlain JM, et al. Patterns of benzodiazepine underdosing in the established status epilepticus treatment trial. Epilepsia. 2021;62(3):795–806.
Alldredge BK, Gelb AM, Isaacs SM, Corry MD, Allen F, Ulrich S, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out‐of‐hospital status epilepticus. N Engl J Med. 2001;345(9):631–637.
Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012;366(7):591–600.
Vigevano F, Kirkham FJ, Wilken B, Raspall‐Chaure M, Grebla R, Lee D, et al. Effect of rescue medication on seizure duration in non‐institutionalized children with epilepsy. Eur J Paediatr Neurol. 2018;22(1):56–63.
Halliday AJ, Santamaria J, D'Souza WJ. Pre‐hospital benzodiazepines associated with improved outcomes in out‐of‐hospital status epilepticus: a 10‐year retrospective cohort study. Epilepsy Res. 2021;179:106846.
Lowenstein DH, Alldredge BK, Allen F, Neuhaus J, Corry M, Gottwald M, et al. The prehospital treatment of status epilepticus (PHTSE) study: design and methodology. Control Clin Trials. 2001;22(3):290–309.
Gaínza‐Lein M, Sánchez Fernández I, Jackson M, Abend NS, Arya R, Brenton JN, et al. Association of Time to treatment with short‐term outcomes for pediatric patients with refractory convulsive status epilepticus. JAMA Neurol. 2018;75(4):410–418.
Herman ST, Detyniecki K, O'Hara K, Penovich P, Rao VR, Tatum W, et al. Written seizure action plans for adult patients with epilepsy: distilling insights from emergency action plans for other chronic conditions. Epilepsy Behav. 2023;140:109002.
Kienitz R, Kay L, Beuchat I, Gelhard S, von Brauchitsch S, Mann C, et al. Benzodiazepines in the Management of Seizures and Status Epilepticus: a review of routes of delivery, pharmacokinetics, efficacy, and tolerability. CNS Drugs. 2022;36(9):951–975.
Ma L, Yung A, Yau E, Kwong K. Clinical guidelines on Management of Prolonged Seizures, serial seizures and convulsive status epilepticus in children. Hong Kong Journal of Paediatrics. 2010;15:52–63.
Scottish Intercollegiate Guidelines Network (SIGN) guideline 143. Diagnosis and management of epilepsy in adults. 2018. Available from: https://wwwsignacuk/media/1079/sign143_2018pdf Accessed April 2023.
Theodore WH, Porter RJ, Albert P, Kelley K, Bromfield E, Devinsky O, et al. The secondarily generalized tonic‐clonic seizure: a videotape analysis. Neurology. 1994;44(8):1403–1407.
Perruca E, French JA, Balestrini S. Which terms should be used to describe medications used in the treatment of epilepsy? An ILAE Position Paper: ILAE. 2023. [Available from: https://www.ilae.org/files/dmfile/terms‐to‐describe‐medications‐used‐in‐the‐treatment‐of‐epilepsy‐‐‐draft.pdf
Segal EB, Tarquinio D, Miller I, Wheless JW, Dlugos D, Biton V, et al. Evaluation of diazepam nasal spray in patients with epilepsy concomitantly using maintenance benzodiazepines: an interim subgroup analysis from a phase 3, long‐term, open‐label safety study. Epilepsia. 2021;62(6):1442–1450.
Haut SR, Shinnar S, Moshé SL, O'Dell C, Legatt AD. The association between seizure clustering and convulsive status epilepticus in patients with intractable complex partial seizures. Epilepsia. 1999;40(12):1832–1834.
Ferastraoaru V, Schulze‐Bonhage A, Lipton RB, Dumpelmann M, Legatt AD, Blumberg J, et al. Termination of seizure clusters is related to the duration of focal seizures. Epilepsia. 2016;57(6):889–895.
Cereghino JJ. Identification and treatment of acute repetitive seizures in children and adults. Curr Treat Options Neurol. 2007;9(4):249–255.
Meritam Larsen P, Wüstenhagen S, Terney D, Gardella E, Aurlien H, Beniczky S. Duration of epileptic seizure types: a data‐driven approach. Epilepsia. 2023;64(2):469–478.
Jenssen S, Gracely EJ, Sperling MR. How long do most seizures last? A systematic comparison of seizures recorded in the epilepsy monitoring unit. Epilepsia. 2006;47(9):1499–1503.
Meletti S, Turchi G, Orlandi N, Vaudano AE, Cioclu MC, Pugnaghi M, et al. Electrographic seizure duration and inter‐seizure intervals in focal status epilepticus. Epileptic Disord. 2023;25(4):519–527.
Abood W, Bandyopadhyay S. Postictal Seizure State. StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
Braatz V, Martins Custodio H, Leu C, Agrò L, Wang B, Calafato S, et al. Postictal psychosis in epilepsy: a Clinicogenetic study. Ann Neurol. 2021;90(3):464–476.
Pottkämper JCM, Hofmeijer J, van Waarde JA, van Putten M. The postictal state ‐ what do we know? Epilepsia. 2020;61(6):1045–1061.
Subota A, Khan S, Josephson CB, Manji S, Lukmanji S, Roach P, et al. Signs and symptoms of the postictal period in epilepsy: a systematic review and meta‐analysis. Epilepsy Behav. 2019;94:243–251.
ILAE. Post‐ictal psychosis: identification, treatment and prevention. Epigraph. 2020;22(2).
Shorvon S, Trinka E. Nonconvulsive status epilepticus and the postictal state. Epilepsy Behav. 2010;19(2):172–175.
Penovich PE, Buelow J, Steinberg K, Sirven J, Wheless J. Burden of seizure clusters on patients with epilepsy and caregivers: survey of patient, caregiver, and clinician perspectives. Neurologist. 2017;22(6):207–214.
Wait S, Lagae L, Arzimanoglou A, Beghi E, Bennett C, Cross JH, et al. The administration of rescue medication to children with prolonged acute convulsive seizures in the community: what happens in practice? Eur J Paediatr Neurol. 2013;17(1):14–23.
Roberg LE, Monsson O, Kristensen SB, Dahl SM, Ulvin LB, Heuser K, et al. Prediction of Long‐term survival after status epilepticus using the ACD score. JAMA Neurol. 2022;79(6):604–613.