Abstracts

Rationale: Rescue medications are essential to treat prolonged seizures and clusters of seizures in pediatric patients with epilepsy, and can reduce the need for hospitalization. There is limited information available to guide their use and while several rescue medications and delivery options exist, only rectal diazepam is FDA approved. We sought to qualify how the experts, pediatric epileptologists and neurologists, prescribe these medications. Methods: A REDCap email survey was sent to the members of the Pediatric Epilepsy Research Consortium (PERC), a group of United States pediatric epilepsy providers which includes pediatric epileptologists, pediatric neurologists and pediatric advanced practice providers. Responses were identifiable only to the respondent's region of practice. The survey consisted of 35 entries (free text and multiple choice questions) on the following topics: choice of rescue medication for children of different age and neurocognitive development, timing of medication administration, dosing, other prescribing practices and demographic information. Results: A total of 36 respondents, including 34 pediatric epileptologists and 2 pediatric neurologists, completed the survey. Their length of experience ranged from 1 to 30 years. Respondents were from all regions of the United States. In patients with a history of prolonged convulsive seizures, rectal diazepam was the most frequently chosen first line rescue medication for severely developmentally delayed 16 year olds (44%), both developmentally typical and delayed 7 (44%, 61%) and 3 year olds (78%, 86%), and developmentally typical 9 month olds (83%). 69% of responders indicated that developmentally typical 16 year olds would be prescribed intranasal midazolam. For patients with clusters of seizures, clonazepam wafers were the most frequent first line option in all age groups except developmentally delayed 3 year olds and 9 month old children in which rectal diazepam was more commonly chosen. Across all age groups, a median of 5 minutes was the recommended time to administer rescue medication. 58% indicated that they advise repeating an initial dose of rescue medication for continued seizure activity in all patients, 17% repeat a dose in patients older than 2 years, and 6% repeat a dose in patients older than 6 years. Of these, 83% repeat a full dose at a median of 5 minutes after the first dose. Most providers (78%) do not routinely test rescue medications in the hospital prior to outpatient use. The earliest age at which providers felt comfortable prescribing rescue medications was at a median of 3 months. Conclusions: Rectal diazepam remains the most frequently used rescue medication for seizures amongst nearly all age groups except in developmentally typical teenagers where nasal midazolam is used more often. Clonazepam wafers are the most frequently used medication for treatment of clusters of seizures except in younger patients. The choice of rescue medication must be made on a patient-to-patient basis accounting for each individual's specific seizure history. Funding: None.