Recommendations for Out-Of-Hospital Seizure Management Presented At AES 2024

New recommendations for the management of seizure in out-of-hospital settings by non-healthcare personnel were presented at the American Epilepsy Society (AES) 2024 Annual Meeting. The recommendations, which were published earlier in 2024 in Neurology, detail the patient groups for which Rapid Epileptic Seizure Termination (REST) is suitable and outline the optimal timeline for preventing negative outcomes resulting from seizure, including irreversible neuronal damage, late-onset epileptogenesis, and sudden unexpected or premature death.

The recommendations were produced by an expert panel of 11 epileptologists who developed a consensus on standardized definitions and the optimal protocol for out-of-hospital seizure management through a review of scientific literature.

Key recommendations include the following:

• REST treatment should be administered to all patients with epileptic auras, those with antiseizure medication (ASM) withdrawal, and those at risk of prolonged or cluster seizures.
• People in cluster or prolonged seizure risk situations including poor medication compliance, severe emotional stress, or sleep deprivation may also receive REST treatment.
• REST treatment should be administered within a 2-minute threshold of seizure onset.
• A 2-minute threshold for treatment administration also should be followed for people with prolonged seizures with motor symptoms or those with generalized tonic-clonic seizures.
• Prolonged seizures without motor symptoms should be treated based on seizure duration and progression.
• Seizure clusters should be treated if their frequency doubles within 8 hours.
• Generalized tonic-clonic clusters should be treated if the onset of a second seizure occurs within 24 hours.
• The threshold for REST treatment implementation should be shortened based on seizure frequency and duration.