Rescue epilepsy medication and training: A comparison between midazolam use, guidelines, clinical practice, and possibilities in the UK and Norway

Objectives: Status epilepticus (SE) is a prolonged epileptic seizure carrying significant risk of long‐term disability and death. Rescue therapies are prescribed for prehospital administration to terminate SE. This study compared prescribing practices of rescue therapies of midazolam in the UK and Norway. Methods: A cross‐sectional, online, 21‐item Likert‐style survey was administered to epilepsy professionals in the UK circulated via ILAE/ESNA and in Norway via ILAE/Epilepsinet using a non‐discriminatory exponential snowballing technique leading to non‐probability sampling. Data were collected anonymously and analyzed using descriptive statistics, Mann–Whitney, Chi‐square, and Fisher's exact tests. Significance was accepted at p < 0.05. Results: All 86 UK and 53 Norway respondents identified buccal midazolam as the first‐line rescue medication choice in the community for prolonged and/or generalized tonic–clonic seizures. Norwegian respondents had significantly more experience in epilepsy‐related work (p = 0.002), were more likely to have a larger caseload on buccal midazolam (p < 0.001), prescribed higher midazolam doses (p < 0.001), and provided training yearly (p < 0.001). UK respondents were more likely to delegate rescue medication prescribing to primary care (p = 0.006) and reviewed emergency management plans more frequently (p = 0.006). There was an inter‐country difference in the period of midazolam non‐use that respondents required before withdrawing from treatment plans (p < 0.001). Concern about inappropriate use of buccal midazolam was similarly high in both countries. Significance: This study compared epilepsy professionals in two neighboring high‐income countries. Findings suggest an urgent need for international guidelines to recommend best practices on prescribing doses and withdrawal of buccal midazolam. The potential abuse of buccal midazolam by patients and carers warrants further investigation. Plain Language Summary: This study investigated doctors' and nurses' views on the use of epilepsy rescue therapies, particularly midazolam. These are medications that can stop dangerously long epileptic seizures from progressing to the point of serious injury or death. The study was carried out in both the UK and Norway to establish differences between the countries. The key findings were that Norwegian doctors prescribed rescue medications at a higher dose, that UK clinicians reviewed and deprescribed medications faster after patients stopped having prolonged seizures, and that clinicians in both countries were concerned about medications being misused or abused by patients and carers.