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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 
minutes. Why do we pick that number so often? 
#neurotwitter #medtwitter #tweetorial
minutes. Why do we pick that number so often? #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/
Several studies have looked at this. Let’s begin with Shinnar, et al 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
%. 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.
Seizure duration was mean 3.6 min for
%. 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.
4) The next paper by Jenssen et al looked at duration of seizures for adults in an EMU setting.
579 seizures in 159 adults showed median seizure durations were <2min for multiple seizure types (see next figure). https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2006.00622.x
579 seizures in 159 adults showed median seizure durations were <2min for multiple seizure types (see next figure). https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2006.00622.x
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/
T1: time treatment should be initiated
T2: time when long-term consequences may appear 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...
