Aims To investigate the effect of rescue medication on seizure duration in children with epilepsy who have prolonged acute convulsive seizures (PACS).

Methods Practices in Emergency and Rescue medication For Epilepsy managed with Community-administered Therapy 3 (PERFECT-3) was a cross-sectional study in Germany, Italy, Spain and the UK. Eligible patients were non-institutionalised children aged 3–16 years who had been diagnosed with epilepsy ≥ 12 months previously, had experienced ≥ 1 PACS within the last 12 months and had currently prescribed rescue medication (s) for PACS. Investigators provided clinical assessments and parents/guardians completed web-based questionnaires. Parents were asked how long a prolonged seizure experienced by their child lasts on average without rescue medication and after rescue medication has been given; seizure start-point and end-point were not defined and no measurements were requested. Statistical tests were post hoc; p values are descriptive, non-inferential and uncorrected for multiple comparisons.

Results At baseline, most of the 286 enrolled patients had prescriptions for diazepam (69.2%) or midazolam (55.9%), and some had two (26.6%) or three (2.4%) prescribed rescue medications. According to parents (n = 258), the average length of children’s prolonged seizures without rescue medication was 0 to < 5 min in 35.7% of patients, 5 to < 20 min in 42.6% and ≥ 20 min in 21.7%. When rescue medication was given, parents reported that seizures lasted 0 to < 5 min in 69.4% of patients, 5 to < 20 min in 25.6% and ≥ 20 min in 5.0%. Rescue medication was significantly associated with shorter seizures lasting < 5 min, compared with seizures lasting ≥ 5 min (X² = 58.8; p < 0.0001).

Conclusion In this parent-reported survey of children with epilepsy who had ≥ 1 PACS in the previous year, fewer children experienced seizures lasting ≥ 20 min when rescue medication was given, compared with when it was not given. Most children’s seizures lasted ≥ 5 min without rescue medication, but most children experienced seizures lasting < 5 min when rescue medication was given, suggesting a reduced risk of developing status epilepticus.