Healthcare providers' prescribing practices and emergency management planning for pre-hospital seizure emergencies: A comparison of Hungary to Norway and the United Kingdom.

BACKGROUND

Seizure emergencies, include prolonged seizures and status epilepticus (SE). Benzodiazepines are recommended as first-line rescue therapy. We investigate prescribing practices, emergency planning, and clinician experiences regarding rescue medication in Hungary and compare findings with those from the United Kingdom and Norway.

METHODS

A cross-sectional online survey (CHERRIES-compliant) was conducted between March and October 2025 among neurologists and pediatric neurologists in Hungary. The questionnaire explored demographics, prescribing behaviours, emergency management planning, and training practices. Descriptive statistics were used for Hungarian data, and comparative analyses with the combined UK and Norwegian cohorts were performed using chi-squared, Fisher's exact, and Mann-Whitney U tests with Bonferroni correction.

RESULTS

Fifty-six clinicians participated in Hungary, predominantly neurologists (67.9%), with 60.7% having over 10 years' experience. Midazolam was prescribed by 69% of respondents, significantly lower than in the UK and Norway (100%, p < 0.01). Concerns regarding inappropriate use were reported by 27% in Hungary versus 72% in comparator countries (p < 0.01). A maximum 24-hour dose of 20 mg was most reported (58.5%). Prescribing preferences differed by seizure type, with greater use of nasal midazolam and rectal diazepam in Hungary, while buccal midazolam predominated in the UK and Norway. Emergency plan review frequency and training modalities also varied, with Hungary relying more on face-to-face training.

CONCLUSION

While midazolam was widely prescribed, significant international differences were observed in prescribing patterns, administration routes, and training practices. Further research is needed to determine whether guidelines standardisation, training frameworks, and improved access to rescue therapies could reduce these differences across healthcare settings.