A Proposed Rapid Therapeutic Intervention for Seizures with High Risk of Progressing to Status Epilepticus

Abstract

Status epilepticus is defined as a seizure that persists above a threshold length of time or is repeated frequently without recovery of consciousness between attacks. At present, seizures lasting 5-15 min are considered early status epilepticus according to the revised definition by the International League Against Epilepsy. Emergency treatment for these seizures is also started at the same time. Although treatment strategies for the early, established, and refractory stages of status epilepticus are well described in the Japanese clinical practice guidelines for epilepsy, recent results of clinical studies and recommendations in Western clinical practice guidelines suggest a need for more rapid treatment for seizures with a high risk of progressing to status epilepticus. In this paper, we summarize the results and recommendations of current Western guidelines. We also propose a treatment strategy based on our assessment of these summarizations. Herein, our recommended treatment strategy is referred to as "First Aid for Seizure Termination (FAST)." FAST targets the onset of 1) seizure clusters, and 2) prolonged seizures.