Treatment administration during a seizure in home-settings: Time to treat (TT)

Early intervention on prolonged and cluster seizures can avoid serious consequences such as irreversible neuronal damage, late onset epileptogenesis, sudden unexpected death, and premature death, among others. In addition, it can prevent progression to status epilepticus, which has a mortality rate of 20%. However, prehospital diagnosis and treatment of seizures is often delayed, as patients receive treatment 30minutes past seizure onset even though most seizures last less than 2minutes. The aim of this consensus was to determine the time at which rapid and early seizure termination (REST) drugs should be administered in home-settings.

Eleven epileptologists reviewed and discussed the scientific literature in face-to-face work meetings, followed by individual work. Recommendations for the management of prolonged and cluster seizures in the home-setting were established.

Patients with epilepsy should be considered candidates to receive REST treatment in home-seeting if they are at risk of prolonged seizures or clusters, as well as if they experience prodromal symptoms, auras, or epileptic seizures that alert of a more severe seizure that lead to impaired consciousness or generalize tonic-clonic. Additionally, this treatment should be considered for individuals who, despite not having epilepsy, are at risk of experiencing a seizure, such as those with a history of febrile seizures, acute brain injuries with seizures, or patients undergoing withdrawal from anti-seizure treatment. The general recommendation is to administer REST treatment two minutes after the onset of a seizure or when clustered seizures occur at twice the usual frequency within an eight-hour period. In cases of generalized tonic-clonic seizures, intervention should be even more prompt. Treatment timing should always be individualized for each patient, considering the characteristics of their usual seizures. The neurologist must prescribe the medication with instructions for it to be administered in the patient's home setting.

In general, the administration of REST medications by non-healthcare personnel should follow these recommendations: medication should be given for epileptic seizures lasting 2minutes or in cases where the frequency of seizures doubles compared to usual. This is crucial in most cases, while always considering the recommendations of the physician.