Marina Gaínza-Lein1, Robert Benjamin2, Coral Stredny3, Marlee McGurl4, Kush Kapur5, Tobias Loddenkemper6. 1. Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile. Electronic address: m.gainzalein@gmail.com. 2. Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Assumption College, Worcester, MA, United States. Electronic address: robert.benjamin@assumption.edu. 3. Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: coral.stredny@childrens.harvard.edu. 4. Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: marlee.mcgurl@gmail.com. 5. Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: kush.kapur@childrens.harvard.edu. 6. Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: tobias.loddenkemper@childrens.harvard.edu.
Abstract
PURPOSE: 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. METHOD: Cross-sectional observational study based on surveys to families of pediatric patients with epilepsy and based on medical chart review. RESULTS: 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). CONCLUSIONS: 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.
PURPOSE: 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. METHOD: Cross-sectional observational study based on surveys to families of pediatric patients with epilepsy and based on medical chart review. RESULTS: 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). CONCLUSIONS: 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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Authors: Alejandra Vasquez; Marina Gaínza-Lein; Nicholas S Abend; Marta Amengual-Gual; Anne Anderson; Ravindra Arya; J Nicholas Brenton; Jessica L Carpenter; Kevin Chapman; Justice Clark; Raquel Farias-Moeller; William D Gaillard; Tracy Glauser; Joshua L Goldstein; Howard P Goodkin; Rejean M Guerriero; Kush Kapur; Yi-Chen Lai; Tiffani L McDonough; Mohamad A Mikati; Lindsey A Morgan; Edward J Novotny; Adam P Ostendorf; Eric T Payne; Katrina Peariso; Juan Piantino; James J Riviello; Kumar Sannagowdara; Robert C Tasker; Dmitry Tchapyjnikov; Alexis Topjian; Mark S Wainwright; Angus Wilfong; Korwyn Williams; Tobias Loddenkemper Journal: Neurology Date: 2020-09-10 Impact factor: 9.910