Abstract
Objectives: Status epilepticus (SE) is a prolonged epileptic seizure carrying significant risk of long-term disability and death. Rescue therapies are prescribed
for prehospital administration to terminate SE. This study compared prescribing
practices of rescue therapies of midazolam in the UK and Norway.
Methods: A cross-sectional, online, 21-item Likert-style survey was administered
to epilepsy professionals in the UK circulated via ILAE/ESNA and in Norway via
ILAE/Epilepsinet using a non-discriminatory exponential snowballing technique
leading to non-probability sampling. Data were collected anonymously and analyzed using descriptive statistics, Mann–Whitney, Chi-square, and Fisher's exact tests. Significance was accepted at p<0.05.
Results: All 86 UK and 53 Norway respondents identified buccal midazolam as the first-line rescue medication choice in the community for prolonged and/or generalized tonic–clonic seizures. Norwegian respondents had significantly more experience in epilepsy-related work (p=0.002), were more likely to have a larger caseload on buccal midazolam (p<0.001), prescribed higher midazolam doses (p<0.001), and provided training yearly (p<0.001). UK respondents were more likely to delegate rescue medication prescribing to primary care (p=0.006) and reviewed emergency management plans more frequently (p=0.006). There was an inter-country difference in the period of midazolam non-use that respondents required before withdrawing from treatment plans (p<0.001). Concern about inappropriate use of buccal midazolam was similarly high in both countries.
Significance: This study compared epilepsy professionals in two neighboring
high-income countries. Findings suggest an urgent need for international guidelines to recommend best practices on prescribing doses and withdrawal of buccal midazolam. The potential abuse of buccal midazolam by patients and carers warrants further investigation.
for prehospital administration to terminate SE. This study compared prescribing
practices of rescue therapies of midazolam in the UK and Norway.
Methods: A cross-sectional, online, 21-item Likert-style survey was administered
to epilepsy professionals in the UK circulated via ILAE/ESNA and in Norway via
ILAE/Epilepsinet using a non-discriminatory exponential snowballing technique
leading to non-probability sampling. Data were collected anonymously and analyzed using descriptive statistics, Mann–Whitney, Chi-square, and Fisher's exact tests. Significance was accepted at p<0.05.
Results: All 86 UK and 53 Norway respondents identified buccal midazolam as the first-line rescue medication choice in the community for prolonged and/or generalized tonic–clonic seizures. Norwegian respondents had significantly more experience in epilepsy-related work (p=0.002), were more likely to have a larger caseload on buccal midazolam (p<0.001), prescribed higher midazolam doses (p<0.001), and provided training yearly (p<0.001). UK respondents were more likely to delegate rescue medication prescribing to primary care (p=0.006) and reviewed emergency management plans more frequently (p=0.006). There was an inter-country difference in the period of midazolam non-use that respondents required before withdrawing from treatment plans (p<0.001). Concern about inappropriate use of buccal midazolam was similarly high in both countries.
Significance: This study compared epilepsy professionals in two neighboring
high-income countries. Findings suggest an urgent need for international guidelines to recommend best practices on prescribing doses and withdrawal of buccal midazolam. The potential abuse of buccal midazolam by patients and carers warrants further investigation.
| Original language | English |
|---|---|
| Journal | Epilepsia Open |
| DOIs | |
| Publication status | Published - 6 Oct 2025 |
ASJC Scopus subject areas
- Neurology
- Neurology (clinical)
Keywords
- benzodiazepine
- epilepsy mortality
- epilepsy risk
- prolonged seizures
- rescue therapy