Toledo Manuel, García Morales Irene, Serratosa José María, Carreño Martínez Mar, Soto Insuga Víctor, Serrano Castro Pedro, Villanueva Haba Vicente, García Peñas Juan José, Gil-Nagel Rein Antonio, Smeyers Durá Patricia, Rodríguez Uranga Juan
Hospital Vall d'Hebron, Barcelona, España.
Hospital Clínico San Carlos, Madrid, España.
Med Clin (Barc). 2025 Aug;165(2):106996. doi: 10.1016/j.medcli.2025.106996. Epub 2025 May 22.
Early intervention on prolonged and cluster seizures can avoid serious consequences such as irreversible neuronal damage, late onset epileptogenesis, sudden unexpected death, and premature death, among others. In addition, it can prevent progression to status epilepticus, which has a mortality rate of 20%. However, prehospital diagnosis and treatment of seizures is often delayed, as patients receive treatment 30minutes past seizure onset even though most seizures last less than 2minutes. The aim of this consensus was to determine the time at which rapid and early seizure termination (REST) drugs should be administered in home-settings.
Eleven epileptologists reviewed and discussed the scientific literature in face-to-face work meetings, followed by individual work. Recommendations for the management of prolonged and cluster seizures in the home-setting were established.
Patients with epilepsy should be considered candidates to receive REST treatment in home-seeting if they are at risk of prolonged seizures or clusters, as well as if they experience prodromal symptoms, auras, or epileptic seizures that alert of a more severe seizure that lead to impaired consciousness or generalize tonic-clonic. Additionally, this treatment should be considered for individuals who, despite not having epilepsy, are at risk of experiencing a seizure, such as those with a history of febrile seizures, acute brain injuries with seizures, or patients undergoing withdrawal from anti-seizure treatment. The general recommendation is to administer REST treatment two minutes after the onset of a seizure or when clustered seizures occur at twice the usual frequency within an eight-hour period. In cases of generalized tonic-clonic seizures, intervention should be even more prompt. Treatment timing should always be individualized for each patient, considering the characteristics of their usual seizures. The neurologist must prescribe the medication with instructions for it to be administered in the patient's home setting.
In general, the administration of REST medications by non-healthcare personnel should follow these recommendations: medication should be given for epileptic seizures lasting 2minutes or in cases where the frequency of seizures doubles compared to usual. This is crucial in most cases, while always considering the recommendations of the physician.
对长时间发作和丛集性发作进行早期干预可避免诸如不可逆的神经元损伤、迟发性癫痫发生、不明原因猝死和过早死亡等严重后果。此外，还可预防进展为癫痫持续状态，其死亡率为20%。然而，癫痫发作的院前诊断和治疗常常延迟，因为患者在癫痫发作开始30分钟后才接受治疗，而大多数癫痫发作持续时间不到2分钟。本共识的目的是确定在家中应在何时给予快速早期癫痫发作终止（REST）药物。
11名癫痫专家在面对面工作会议及随后的个人工作中对科学文献进行了审查和讨论。制定了在家中处理长时间发作和丛集性发作的建议。
如果癫痫患者有长时间发作或丛集性发作的风险，以及出现前驱症状、先兆或癫痫发作提示更严重发作并导致意识障碍或全身强直阵挛发作，应被视为在家中接受REST治疗的候选者。此外，对于虽无癫痫但有癫痫发作风险的个体，如既往有热性惊厥史、急性脑损伤伴癫痫发作或正在接受抗癫痫治疗撤药的患者，也应考虑进行这种治疗。一般建议在癫痫发作开始两分钟后或在八小时内发作频率为平时两倍的丛集性发作时给予REST治疗。对于全身强直阵挛发作，干预应更迅速。治疗时机应根据每个患者的情况个体化，考虑其通常发作的特点。神经科医生必须开具药物并指导在患者家中给药。
一般来说，非医护人员给予REST药物应遵循以下建议：癫痫发作持续2分钟或发作频率比平时增加一倍时应给药。在大多数情况下这至关重要，同时始终要考虑医生的建议。
