Clinical practices in prehospital rescue medication use for pediatric status epilepticus in Japan: a nationwide questionnaire survey.

BACKGROUND

Status epilepticus (SE) is a neurological emergency requiring rapid treatment. While prehospital management is critical, practices regarding rescue medication use and caregiver guidance, including emergency service activation, remain unclear.

METHODS

We conducted a nationwide, web-based survey of pediatric neurologists between January and March 2025. One representative from each institution reported on rescue medication prescribing and caregiver instructions for prehospital seizure management. The survey assessed indications for buccal midazolam, scenario-based recommendations, and post-administration guidance.

RESULTS

Of 136 responses, 134 respondents who were aware of buccal midazolam were included; 118 had prescribing experience. A history of prolonged convulsive seizures, particularly ≥30 min (95.5% high-priority), was consistently identified as a high-priority indication. Seizures lasting 5-30 min were also considered appropriate (57.5% high-priority, 38.1% low-priority), with greater variability. In contrast, frequent seizures alone were often regarded as appropriate (44.8% low-priority) but rarely high-priority (16.4%). Diagnostic categories such as epilepsy or febrile seizures themselves were not regarded as appropriate indications. Environmental factors, including distance from medical facilities, were also relevant. Similar patterns were observed in scenario-based recommendations, with consistent findings across epilepsy and febrile seizure scenarios. Caregiver instructions varied widely, particularly regarding emergency service activation. In-hospital management was generally unchanged regardless of prehospital rescue medication use.

CONCLUSIONS

Prehospital rescue medication prescribing is primarily guided by seizure duration rather than diagnostic categories. Variability in caregiver instructions highlights the need for clearer guidance to optimize prehospital seizure management.