ORCID
- Rohit Shankar: 0000-0002-1183-6933
Abstract
Background: Epilepsy is one of the commonest neurological conditions worldwide and confers a significant mortality risk, partly driven by status epilepticus (SE). Terminating SE is the goal of pharmaceutical rescue therapies. This survey evaluates UK-based healthcare professionals’ clinical practice and experience in community-based rescue therapy prescribing. Methods: A cross-sectional, 21 item questionnaire composed of Likert-style and free-text based questions was administered online. It was distributed through a non-discriminative snow-balling methodology to members of the Epilepsy Specialist Nurses’ Association (ESNA) and the British International League Against Epilepsy (ILAE). Quantitative analysis used Chi-squared, Fishers’ exact and Mann-Whitney tests. Qualitative data were analysed through NVivo 14 software, following Braun and Clarke methodology. Results: 86 participants comprising of nurses (n = 64) and doctors (n = 21) responded. Participants’ responses reflected guideline-concordant use of emergency management plans and buccal midazolam (BM) as a first-choice therapy for terminating tonic-clonic seizures in SE. However, significant variation (P < 0.05) was found between doctors and nurses in prescribing practices of BM including maximum dose prescribed/day, withdrawal plans and the use in multimorbid patients. Eight themes were identified with some suggestive of concerns of overuse, misuse and abuse of BM by patients/carers. Conclusion: This is the first study to give insights to community management of SE using rescue therapies particularly BM. Further evidence-based guidelines are needed for BM use in multimorbid patients and for its deprescribing. Robust safeguarding protocols and vigilance is needed to regulate BM's misuse and abuse potential. Oncoming community-based technology could provide objective assurance for evidencing utility of rescue medications.
Publication Date
2025-01-01
Publication Title
Seizure: European Journal of Epilepsy
Volume
125
ISSN
1059-1311
Keywords
Benzodiazepine, Epilepsy mortality, Epilepsy risk, Rescue therapy, Seizures
First Page
62
Last Page
72
Recommended Citation
Shankar, R. (2025) 'The current clinical practice and experiences in buccal midazolam prescribing in community for status epilepticus termination in the United Kingdom: The Rescue Epilepsy Medication and Training (REMIT) study', Seizure: European Journal of Epilepsy, 125, pp. 62-72. Available at: 10.1016/j.seizure.2024.12.022
