Febrile status epilepticus: time is of the essence.

Commentary Multiple steps and prerequisites may cause delay and variability in the recognition and treatment of febrile seizures and febrile status epilepticus. Among the challenges are identification of patients at risk of febrile convulsive status and detection of febrile seizures and febrile status epilep-ticus. If symptoms are noted by nonmedical personnel, including parents or caretakers, seizures and febrile status epilepticus need to ideally be recognized as such. Families either need to bring the patient to medical attention or may need access to acute treatment options and need to know how to apply treatment, and then contact medical providers to determine further work-up and care as indicated. Medical service providers, be it emergency medical services (EMS), emergency department (ED), primary care, or neurologist, may need to have febrile status rescue medications available and need to be able to give initial treatment, recognize treatment failure, and escalate treatment when initial interventions are not effective. Seizure Detection and Recognition While the percentage of parents who do not bring their children with febrile status epilepticus to medical attention for prolonged periods of time may be minimal, there are occasional families who elect to wait. Deterrents and distractors from medical care may vary, including limited awareness of acuity and emergency, access to emergency care, long wait times, or relatively more urgent competing family tasks among others. Mutual collaboration to provide children with better access and families in need with better education of this emergency is crucial. Cardiologists and stroke specialists have demonstrated that time to treatment in myocardial infarct patients (" Time is muscle ") or stroke patients (" Time is brain ") can be improved. This education may also include education regarding varying seizure symptoms and interventions. Despite best intentions and counseling though, seizure onset may occur unwitnessed. To date, there are no clear guidelines regarding the role of novel seizure detection tools, baby monitors, actigraphy sensors, movement sensors, smart clothing, or cameras and other devices detecting seizures, while some of these techniques may benefit patients at risk, allowing easier detection by parents or medical care providers (1). Availability and Application of Rescue Medication Not all parents of children with a history of convulsive febrile seizures and status receive counseling and a prescription for OBJECTIVE: Treatment of seizures varies by region, with no standard emergency treatment protocol. Febrile status epilep-ticus (FSE) is often a child's first seizure; therefore, families are rarely educated about emergency …