Effect of rescue medication on seizure duration in non-institutionalized children with epilepsy

Objectives: Characterize the real-world management of and outcomes for children with epilepsy receiving rescue medication for prolonged acute convulsive seizures (PACS) in the community. Methods: PERFECT-3 (Practices in Emergency and Rescue medication For Epilepsy managed with Community-administered Therapy 3) was a European, retrospective observational study. Eligible patients were non-institutionalized children with epilepsy aged 3-16 years who had experienced >= 1 PACS in the past year and had >= 1 currently prescribed PACS rescue medication. Investigators provided clinical assessments and parents/guardians completed questionnaires. Statistical tests were post hoc; p values are descriptive. Results: At enrollment (N = 286), most patients had prescriptions for diazepam (69.2%) and/or midazolam (55.9%); some had two (26.6%) or three (2.4%) prescribed rescue medications. Most patients experienced PACS despite regular anti-epilepsy medication. According to parents, the average duration of their child's seizures without rescue medication was <5 min in 35.7% of patients, 5-<20 min in 42.6%, and >= 20 min in 21.7% (n = 258); with rescue medication seizure duration was <5 min in 69.4% of patients, 5-<20 min in 25.6%, and >= 20 min in 5.0%. Rescue medication use was significantly associated with average seizures lasting <5 min (chi(2) = 58.8; p < 0.0001). At the time of their most recent PACS, 58.5-67.8% of children reportedly received rescue medication within 5 min of seizure onset, and 85.4-94.1% within 10 min. Conclusion: This study provides the first real-world data that rescue medications administered in the community reduce the duration of PACS in children with epilepsy. Study limitations including potential recall bias are acknowledged. (C) 2017 Shire Development LLC and The Authors. Published by Elsevier Ltd on behalf of the European Paediatric Neurology Society.