Treatment of epileptic seizures as medical emergencies: a prospective analysis of a decision tree for nonmedically trained staff

The aim of this study was to evaluate the benefit of treating every epileptic seizure as an emergency and to propose a decision tree for use by nonmedical staff. Published literature on emergency medical treatment for seizures was reviewed. A detailed decision tree was developed for use by nonmedical staff. Its effectiveness was prospectively analysed over 16 months. Each seizure was logged, and its duration and severity were recorded. Type, dose, and time of antiepileptic treatment were noted. Results were compared with a 6-month retrospective review. Initiation of antiepileptic drug treatment 5 or 7 minutes after seizure onset was indicated in the tree. Rectal diazepam or lorazepam, or fast-dissolving lorazepam was used. Use of the decision tree resulted in decreased duration of seizures, which lasted up to 18 hours in the retrospective review compared with only 37 minutes in the prospective study. Using this tree, nonmedical staff can appropriately treat adults experiencing seizures. Duration, severity, and frequency of seizures decreased when every seizure was treated as a medical emergency. Implementation of a decision tree is recommended for establishments with patients prone to seizures. It can also be taught to caregivers and parents of patients with well-known epilepsy.