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Abstract Details

Expert Consensus Recommendations on Seizure Emergencies Suitable for Rapid and Early Seizure Termination (REST) and Timing of Intervention
Epilepsy/Clinical Neurophysiology (EEG)
P9 - Poster Session 9 (8:00 AM-9:00 AM)
1-003
Rapid and early seizure termination (REST) has been proposed as a treatment goal for early initiation of rapid treatment to terminate ongoing seizures. Although international guidance exists for status epilepticus (SE), such resources are lacking for PS and SC. We previously reported consensus recommendations on definitions for different types of PS and SC, REST, and new terminology describing acute outpatient treatments. 

To develop expert consensus recommendations for the outpatient management of certain prolonged seizures (PS) and seizure clusters (SC) to prevent progression to more severe seizure types or seizure emergencies. 

An expert group comprising 12 European and American pediatric/adult epileptologists, neurologists and pharmacologists employed a modified Delphi consensus methodology to develop and anonymously vote on recommendations. Consensus was defined as ≥75% (9/12) voting ‘Agree’/‘Strongly agree’.

Consensus was reached on which patients with specific seizure types warrant REST, and on advice to patients/caregivers regarding when to administer outpatient treatment. All experts agreed that all patients who have experienced PS should be offered REST medication, and all who have experienced SC should be offered medication to prevent subsequent seizures. When prescribing outpatient medication, a seizure action plan should be agreed in consultation with patients/caregivers. All experts agreed that for patients whose main seizure pattern is SC, medication to prevent subsequent seizures should be considered at first seizure onset, and 11/12 agreed that patients with a history of PS and recognizable pattern of onset should administer REST medication as early as possible.

High levels of agreement were reached on recommendations for seizure types warranting treatment to terminate ongoing seizures/seizure clusters as rapidly as possible, and on advice for patients/caregivers regarding when to use outpatient medications. These expert consensus recommendations will provide clearer guidance to clinicians, patients and caregivers, and aid establishment of REST as a new paradigm for prolonged seizure management.

Authors/Disclosures
Michael Chez, MD, FAAN (Sutter Medical Group)
PRESENTER
Dr. Chez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ucb. Dr. Chez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for marinus. Dr. Chez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for SK Pharma. Dr. Chez has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Eiasai UCB Neurelis aquestiveGW. The institution of Dr. Chez has received research support from Marinus GW Eisai.
Jesus E. Pina-Garza, MD (Tristar Children's Specialists) Dr. Pina-Garza has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Jazz. Dr. Pina-Garza has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neurelis. Dr. Pina-Garza has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sk. Dr. Pina-Garza has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB. Dr. Pina-Garza has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Analysis Group/Acadia. Dr. Pina-Garza has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Marinus. Dr. Pina-Garza has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Catalyst. Dr. Pina-Garza has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Same as consultant disclosure. Dr. Pina-Garza has received publishing royalties from a publication relating to health care.
No disclosure on file
Lawrence J. Hirsch, MD, FAAN (Yale University Comprehensive Epilepsy Center) Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for marinus. The institution of Dr. Hirsch has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Accure. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Natus. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Rafa Laboratories, Ltd. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Rapport Therapeutics. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker with Neuropace. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Natus. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a speaker with UCB.
No disclosure on file
Pavel Klein, MD, FAAN (Mid-atlantic Epilepsy and Sleep Center) The institution of Dr. Klein has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Aquestive. The institution of Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Neurelis. The institution of Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB Pharma. The institution of Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for SK Life Sience. The institution of Dr. Klein has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Eisai. The institution of Dr. Klein has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. The institution of Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alliance. The institution of Dr. Klein has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Arvelle Therapeutics. Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Aquestive. Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eisai. Dr. Klein has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for UCB Pharma. Dr. Klein has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for SK Life Sciences. Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sunovion. Dr. Klein has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for PrevEp. Dr. Klein has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Fenwick . Dr. Klein has received research support from DOD/CURE.
Lieven G. Lagae, PhD (University Hospital Gasthuisberg) Dr. Lagae has nothing to disclose.
Raman Sankar, MD, PhD, FAAN (University of California Los Angeles) Dr. Sankar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Sankar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Takeda. Dr. Sankar has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jazz Pharmaceuticals. Dr. Sankar has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for UCB. Dr. Sankar has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Neurelis. Dr. Sankar has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for SK Life Sciences. Dr. Sankar has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for LivaNova. Dr. Sankar has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Eisai. Dr. Sankar has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for BioMarin. Dr. Sankar has received publishing royalties from a publication relating to health care. Dr. Sankar has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with NINDS, NIH.
No disclosure on file
No disclosure on file
No disclosure on file
Eugen Trinka Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bial. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Böhringer Ingelheim. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Everpharma. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GSK. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Takeda. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Liva-Nova. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Newbridge. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sunovion. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GW Pharmaceuticals. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Marinus. The institution of Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arvelle. Eugen Trinka has received research support from Austrian Science Fund (FWF). Eugen Trinka has received research support from Österreichische Nationalbank. Eugen Trinka has received research support from European Union. Eugen Trinka has received research support from GSK. Eugen Trinka has received research support from Biogen. Eugen Trinka has received research support from Eisai. Eugen Trinka has received research support from Novartis. Eugen Trinka has received research support from Red Bull. Eugen Trinka has received research support from Bayer. Eugen Trinka has received research support from UCB. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a other with Neuroconsult Ges.m.b.H..