Sunday, December 3, 2017

Rescue medications in epilepsy patients: A family perspective.

Gaínza-Lein M, Benjamin R, Stredny C, McGurl M, Kapur K, Loddenkemper T. Rescue Medications in Epilepsy Patients: A Family Perspective. Seizure. 2017 Nov;52:188-194.

The aim of this study was to analyze pre-hospital seizure rescue medication (RM) use in a pediatric epilepsy population, caregiver knowledge and comfort, and prescription patterns.
Cross-sectional observational study based on surveys to families of pediatric patients with epilepsy and based on medical chart review.
One hundred (88%) out of 114 families answered the questionnaire. Fifty-five patients were females (55%), with a median (IQR) age of 11 (6-14) years. Eighty-seven (87%) patients had RM prescribed, and 37 (42.5%) used it in the past. In univariate analysis, patients were more likely to have a RM when they had a history of SE (p<0.001), or had seizures ≥30seconds (p=0.001). Patients were not more likely to be prescribed a RM if they were diagnosed at <2years of age, had ≥3 anti-seizure medications (ASM), had a history of seizure clusters or uncontrolled epilepsy, or were currently not on ASMs. In multivariate analysis a history of SE (p=0.02) and seizure duration ≥30seconds (p=0.04) remained significant. Out of 91 families, 68 (75%) prefer a non-rectal RM; this was higher for patients with normal development, and not associated with age or sex. Fifty-three (61%) families reported that they received RM training. Ten (12%) parents did not know the RM name, and 31 (36%) did not know the administration timing. Forty-five (45%) families had a seizure action plan (SAP), and this was a predictor for knowing the RM name (p=0.04), the administration timing (p=0.004), availability of RM at school (p=0.02), and knowing what to do if the RM fails (p=0.008).
Most patients with epilepsy had a RM, but only 61% reported receiving training. Patients were more likely to have a RM if they had prior SE and longer seizure duration. Families with a SAP were more knowledgeable, and schools were more involved.

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