ORCID

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

Acceptance Date

2024-12-31

Deposit Date

2025-01-01

Funding

LW has received honoraria from UCB and Veriton Pharma as an invited speaker outside of this work. PT has received honoraria and support for educational projects from UCB Pharma outside this work. RS is the chief Investigator of the NIHR adopted national Ep-ID register (which is described in the paper and evidence from it used). The Register is supported and monitored by the National Institute of Health Research UK. The funding for each molecule examined by the Register is via an Investigator Initiated Support grant from each of the molecule's parent company. The funding is to RS's NHS institution and goes towards the salary of the research co-ordinator and the institution's project oversight costs. The contributing companies till date include Eisai, UCB, Bial, Jazz pharma (previously GW pharma) and Angelini. In addition to the above RS has received institutional research, travel support and/or honorarium for talks and expert advisory boards from LivaNova, UCB, Eisai, Neuraxpharm, Veriton Pharma, Bial, Angelini, UnEEG and Jazz/GW pharma outside the submitted work. He holds or has held competitive grants from various national grant bodies including Innovate, Economic and Social Research Council (ESRC), Engineering and Physical Sciences Research Council (ESPRC), National Institute of Health Research (NIHR), NHS Small Business Research Initiative (SBRI) and other funding bodies including charities all outside this work. No other author has any declared conflict of interest related to this paper.

Keywords

Benzodiazepine, Epilepsy mortality, Epilepsy risk, Rescue therapy, Seizures

First Page

62

Last Page

72

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