ORCID

Abstract

Objectives: Status epilepticus (SE) is a prolonged epileptic seizure carrying significant risk of long-term disability and death. Rescue therapies are prescribedfor prehospital administration to terminate SE. This study compared prescribingpractices of rescue therapies of midazolam in the UK and Norway.Methods: A cross-sectional, online, 21-item Likert-style survey was administeredto epilepsy professionals in the UK circulated via ILAE/ESNA and in Norway viaILAE/Epilepsinet using a non-discriminatory exponential snowballing techniqueleading to non-probability sampling. Data were collected anonymously and analyzed using descriptive statistics, Mann–Whitney, Chi-square, and Fisher's exact tests. Significance was accepted at p<0.05.Results: All 86 UK and 53 Norway respondents identified buccal midazolam as the first-line rescue medication choice in the community for prolonged and/or generalized tonic–clonic seizures. Norwegian respondents had significantly more experience in epilepsy-related work (p=0.002), were more likely to have a larger caseload on buccal midazolam (p<0.001), prescribed higher midazolam doses (p<0.001), and provided training yearly (p<0.001). UK respondents were more likely to delegate rescue medication prescribing to primary care (p=0.006) and reviewed emergency management plans more frequently (p=0.006). There was an inter-country difference in the period of midazolam non-use that respondents required before withdrawing from treatment plans (p<0.001). Concern about inappropriate use of buccal midazolam was similarly high in both countries.Significance: This study compared epilepsy professionals in two neighboringhigh-income countries. Findings suggest an urgent need for international guidelines to recommend best practices on prescribing doses and withdrawal of buccal midazolam. The potential abuse of buccal midazolam by patients and carers warrants further investigation.

Publication Date

2025-10-06

Publication Title

Epilepsia Open

Acceptance Date

2025-09-01

Deposit Date

2025-10-07

Funding

There is no direct disclosure or conflict of interest for any author for this submitted body of work. OJH has received speakers' honoraria from Eisai, Roche, Jazz, and UCB pharma outside this work. CJL has received speaker/expert group honoraria from Angelini, Eisai, Jazz, and UCB pharma outside this work. LW has received speakers' honoraria from UCB and Veriton pharma outside this work. RS developed the non‐commercial and free‐to‐use SUDEP and Seizure Safety Checklist and the EpSMon app to reduce the risk of SUDEP and enhance seizure safety. RS is the chief investigator of the NIHR‐adopted national Ep‐ID register. 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 toward the salary of the research coordinator and the institution's project oversight costs. The contributing companies to date include Eisai, UCB, Bial, Jazz pharma (previously GW pharma), and Angelini. This work sits outside the submitted work. In addition to the above, RS has received institutional research, travel support, and/or honoraria 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, prolonged seizures, rescue therapy

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Download

Share

COinS