Recommendations for the community-based management of prolonged convulsive seizures in children in Europe

Typically, convulsive epileptic seizures self-terminate within 2–3 min. A duration exceeding 5 min defines convulsive status epilepticus (CSE), a condition that could have detrimental neurological, cognitive and psychiatric consequences. As seizure duration extends towards 5 min, the risk of progression to CSE increases. A prolonged convulsive seizure (PCS) represents a medical emergency with a need for urgent treatment since the chances of spontaneous cessation are low. Generally, a PCS exceeding 5 min should be promptly treated with a rescue medication. However, for those who have already experienced a PCS, or who are at particular risk of a PCS, time to rescue medication administration should be individualized. Buccal midazolam and rectal diazepam are the current first line rescue medications available to treat PCS in Europe in the community setting. Given its ease of administration and social acceptability, buccal midazolam is currently considered by caregivers and neurologists the preferred rescue medication option in the community for children older than 6 months. This document contains the first expert panel recommendations for the management of PCS in children in the community in Europe, including an algorithm for the management of pediatric patients after the first PCS, and provides guidance for a seizure action plan (SAP).