Abstract：
OBJECTIVE: The management of prolonged seizures (PS) and seizure clusters (SC) is impeded by the lack of international, evidence-based guidance. We aimed to develop expert recommendations regarding consensus definitions of PS, SC, and treatment goals to prevent progression to higher-level emergencies such as status epilepticus (SE).
METHODS: An expert working group, comprising 12 epileptologists, neurologists, and pharmacologists from Europe and North America, used a modified Delphi consensus methodology to develop and anonymously vote on statements. Consensus was defined as ≥75% voting \"Agree\"/\"Strongly agree.\"
RESULTS: All group members strongly agreed that termination of an ongoing seizure in as short a time as possible is the primary goal of rapid and early seizure termination (REST) and that an ideal medication for REST would start to act within 2 min of administration to terminate ongoing seizure activity. Consensus was reached on the terminology defining PS (with proposed thresholds of 5 min for prolonged focal seizures and 2 min for prolonged absence seizures and the convulsive phase of bilateral tonic-clonic seizures) and SC (an abnormal increase in seizure frequency compared with the individual patient\'s usual seizure pattern). All group members strongly agreed or agreed that patients who have experienced a PS should be offered a REST medication, and all patients who have experienced a SC should be offered an acute cluster treatment (ACT). Further, when prescribing a REST medication or ACT, a seizure action plan should be agreed upon in consultation with the patient and caregiver.
CONCLUSIONS: The expert working group had a high level of agreement on the recommendations for defining and managing PS and SC. These recommendations will complement the existing guidance for the management of acute seizures, with the possibility of treating them earlier to potentially avoid progression to more severe seizures, including SE.
METHODS: An expert working group, comprising 12 epileptologists, neurologists, and pharmacologists from Europe and North America, used a modified Delphi consensus methodology to develop and anonymously vote on statements. Consensus was defined as ≥75% voting \"Agree\"/\"Strongly agree.\"
RESULTS: All group members strongly agreed that termination of an ongoing seizure in as short a time as possible is the primary goal of rapid and early seizure termination (REST) and that an ideal medication for REST would start to act within 2 min of administration to terminate ongoing seizure activity. Consensus was reached on the terminology defining PS (with proposed thresholds of 5 min for prolonged focal seizures and 2 min for prolonged absence seizures and the convulsive phase of bilateral tonic-clonic seizures) and SC (an abnormal increase in seizure frequency compared with the individual patient\'s usual seizure pattern). All group members strongly agreed or agreed that patients who have experienced a PS should be offered a REST medication, and all patients who have experienced a SC should be offered an acute cluster treatment (ACT). Further, when prescribing a REST medication or ACT, a seizure action plan should be agreed upon in consultation with the patient and caregiver.
CONCLUSIONS: The expert working group had a high level of agreement on the recommendations for defining and managing PS and SC. These recommendations will complement the existing guidance for the management of acute seizures, with the possibility of treating them earlier to potentially avoid progression to more severe seizures, including SE.
摘要：
目的：由于缺乏国际，基于证据的指导。我们旨在就PS的共识定义制定专家建议，SC,和治疗目标，以防止进展为更高水平的紧急情况，如癫痫持续状态（SE）。
方法：专家工作组，由12位癫痫专家组成,神经学家,来自欧洲和北美的药理学家，使用改进的德尔菲共识方法来开发和匿名投票。共识被定义为≥75%的投票\“同意\”/\“强烈同意。
结果：所有小组成员都强烈同意，在尽可能短的时间内终止正在进行的癫痫发作是快速和提前终止癫痫发作（REST）的主要目标，并且理想的REST药物将在给药后2分钟内开始起作用以终止正在进行的癫痫发作活动。在定义PS的术语上达成共识（建议的阈值为5分钟用于局灶性癫痫发作，2分钟用于长期缺席癫痫发作和双侧强直阵挛性癫痫发作的抽搐期）和SC（与单个患者的常规癫痫发作模式相比，癫痫发作频率异常增加）。所有小组成员都强烈同意或同意，应向患有PS的患者提供REST药物，所有经历过SC的患者均应接受急性集束化治疗(ACT).Further,当开REST药物或ACT时，癫痫发作行动计划应与患者和护理人员协商达成一致。
结论：专家工作组就定义和管理PS和SC的建议达成了高度共识。这些建议将补充现行的急性癫痫发作管理指引,有可能更早地治疗它们，以避免进展为更严重的癫痫发作，包括SE。
方法：专家工作组，由12位癫痫专家组成,神经学家,来自欧洲和北美的药理学家，使用改进的德尔菲共识方法来开发和匿名投票。共识被定义为≥75%的投票\“同意\”/\“强烈同意。
结果：所有小组成员都强烈同意，在尽可能短的时间内终止正在进行的癫痫发作是快速和提前终止癫痫发作（REST）的主要目标，并且理想的REST药物将在给药后2分钟内开始起作用以终止正在进行的癫痫发作活动。在定义PS的术语上达成共识（建议的阈值为5分钟用于局灶性癫痫发作，2分钟用于长期缺席癫痫发作和双侧强直阵挛性癫痫发作的抽搐期）和SC（与单个患者的常规癫痫发作模式相比，癫痫发作频率异常增加）。所有小组成员都强烈同意或同意，应向患有PS的患者提供REST药物，所有经历过SC的患者均应接受急性集束化治疗(ACT).Further,当开REST药物或ACT时，癫痫发作行动计划应与患者和护理人员协商达成一致。
结论：专家工作组就定义和管理PS和SC的建议达成了高度共识。这些建议将补充现行的急性癫痫发作管理指引,有可能更早地治疗它们，以避免进展为更严重的癫痫发作，包括SE。
