Approach to the use of rescue medications in children for prolonged epileptic seizures in the community

Prolonged seizures including convulsive status epilepticus (CSE) in children are significant problems to manage in the community. Early treatment may shorten episodes and prevent subsequent mortality and long-term morbidity. It is likely that pre-hospital treatment is an important part of the optimal management of CSE as it helps to optimize the management in a hospital setting. Benzodiazepines were successfully used for many years with rectal diazepam was the mainstay of treatment. More recently buccal and intranasal midazolam have taken over its place due to their efficacy and ease of administration. Buccal midazolam is more acceptable to the careers and parents for the drug to be administered through mouth, rather than rectally in a tense and anxious situation. Intranasal midazolam has recently been approved for use in children in the USA. Although rectal paraldehyde is widely used in acute settings in the UK, there is relatively little evidence to support this practice. This short article outlines some of the more important studies that can help to guide clinical decision making and offers some practical advice for health professionals caring for children with seizures who may need rescue medication.