1) So often, people with #epilepsy are given a rescue medication (ie rectal diazepam or nasal midazolam/diazepam) for #seizures and the instructions are to give after https://abs.twimg.com/emoji/v2/... draggable="false" alt="5️⃣" title="Tastenkappe Ziffer 5" aria-label="Emoji: Tastenkappe Ziffer 5"> minutes. Why do we pick that number so often? https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht"> #neurotwitter #medtwitter #tweetorial
2) The instructions are based on understanding of how long seizures last on average without treatment- our best estimate of the duration at which rescue may be needed to prevent status.

Several studies have looked at this. Let’s begin with Shinnar, et al https://pubmed.ncbi.nlm.nih.gov/11357957/ ">https://pubmed.ncbi.nlm.nih.gov/11357957/...
3) This prospective study measured seizure duration of 407 children with new onset epilepsy.

Seizure duration was mean 3.6 min for https://abs.twimg.com/emoji/v2/... draggable="false" alt="7️⃣" title="Tastenkappe Ziffer 7" aria-label="Emoji: Tastenkappe Ziffer 7">https://abs.twimg.com/emoji/v2/... draggable="false" alt="6️⃣" title="Tastenkappe Ziffer 6" aria-label="Emoji: Tastenkappe Ziffer 6">%. A mean of 31 min was seen in 24%. The authors concluded that a seizures lasting 5-10 minutes were unlikely to stop and rescue was needed.
5)simple partial seizure >6 min and complex partial >10 min were exceptional and likely to progress to status epilepticus and thus require rescue meds.
6)Based on these and several other studies, the @IlaeWeb Task Force released a definition of status epilepticus in 2015 which consisted of two timepoints

T1: time treatment should be initiated
T2: time when long-term consequences may appear https://pubmed.ncbi.nlm.nih.gov/26336950/ ">https://pubmed.ncbi.nlm.nih.gov/26336950/...
7) the Task Force concluded that tonic clonic seizures >5 min should be treated with rescue meds, as longer durations were likely to evolve to status. other seizure types had slightly longer durations...
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