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

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Epileptic Disorders Pub Date : 2024-05-30 DOI:10.1002/epd2.20243

Jesus Eric Pina-Garza, Michael Chez, James Cloyd, Lawrence J. Hirsch, Reetta Kälviäinen, Pavel Klein, Lieven Lagae, Raman Sankar, Nicola Specchio, Adam Strzelczyk, Manuel Toledo, Eugen Trinka

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引用次数: 0

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.

Abstract Image

查看原文本刊更多论文

对长期癫痫发作和癫痫群集的门诊管理，以防止发展为更高级别的急诊：专家工作组的共识建议。

目的：由于缺乏以证据为基础的国际指南，癫痫持续状态（PS）和癫痫群集（SC）的管理受到阻碍。我们旨在就 PS、SC 的共识定义和治疗目标制定专家建议，以防止发展为更高级别的紧急情况，如癫痫状态（SE）：一个由来自欧洲和北美的 12 位癫痫专家、神经学家和药理学家组成的专家工作组采用改良的德尔菲共识方法来制定声明并进行匿名投票。共识的定义是≥75%的人投票表示 "同意"/"非常同意"：所有小组成员都强烈同意，在尽可能短的时间内终止正在进行的癫痫发作是快速和早期癫痫发作终止（REST）的首要目标，而且理想的 REST 药物应在用药后 2 分钟内开始发挥作用，终止正在进行的癫痫发作活动。专家组就定义 PS（局灶性发作持续时间长的阈值为 5 分钟，失神发作持续时间长的阈值为 2 分钟，双侧强直阵挛发作的抽搐期阈值为 2 分钟）和 SC（与个别患者通常的发作模式相比，发作频率异常增加）的术语达成了共识。所有小组成员都非常同意或同意应向出现 PS 的患者提供 REST 药物，并向所有出现 SC 的患者提供急性群集治疗 (ACT)。此外，在开具 REST 药物或 ACT 处方时，应与患者和护理人员协商，商定癫痫发作行动计划：专家工作组对 PS 和 SC 的定义和管理建议达成了高度一致。这些建议将对现有的急性癫痫发作管理指南起到补充作用，有可能提早治疗，从而避免发展为更严重的癫痫发作，包括 SE。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epileptic Disorders 医学-临床神经学

CiteScore

4.10

自引率

8.70%

发文量

138

审稿时长

6-12 weeks

期刊介绍： Epileptic Disorders is the leading forum where all experts and medical studentswho wish to improve their understanding of epilepsy and related disorders can share practical experiences surrounding diagnosis and care, natural history, and management of seizures. Epileptic Disorders is the official E-journal of the International League Against Epilepsy for educational communication. As the journal celebrates its 20th anniversary, it will now be available only as an online version. Its mission is to create educational links between epileptologists and other health professionals in clinical practice and scientists or physicians in research-based institutions. This change is accompanied by an increase in the number of issues per year, from 4 to 6, to ensure regular diffusion of recently published material (high quality Review and Seminar in Epileptology papers; Original Research articles or Case reports of educational value; MultiMedia Teaching Material), to serve the global medical community that cares for those affected by epilepsy.