Policy briefing

Guidelines on training carers to treat epileptic seizures

Guidelines on training carers who oversee the use of buccal midazolam have been issued by the Epilepsy Nurses Association

Guidelines on training carers who oversee the use of buccal midazolam, the first-line emergency treatment for an epileptic seizure in the community, have been issued by the Epilepsy Nurses Association

Image representing section of brain showing area of focal seizure, overlaid with EEG. New guidelines have been issued on training carers in first-line emergency treatment for epileptic seizures in the community.
Image representing section of brain showing area of focal seizure, overlaid with EEG.
Picture: Science Photo Library

Essential information

Epilepsy is a serious neurological condition that can affect anyone, at any age, according to the charity Epilepsy Action. The condition affects around one in every 100 people in the UK. Every day, 87 people are diagnosed.

Buccal midazolam is recognised as the first-line emergency treatment used during a seizure in the community.

What’s new?

Training guidelines for administering buccal (oromucosal) midazolam for people with epilepsy in the community have been issued by the Epilepsy Nurses Association (ESNA).

The ESNA guidelines support best practice when nurses and other staff are training carers who oversee the use of buccal midazolam for the treatment of prolonged or clusters of epileptic seizures.

An online assessment tool introduced alongside the guidelines can be purchased via the association’s website.

This enables a knowledge check to be undertaken following recommended training for those who are caring for people with epilepsy in healthcare and private care settings.

The guidelines, produced in collaboration with the International League Against Epilepsy and the Royal College of Psychiatrists, outline important safety standards for first aid intervention, while demonstrating the need for awareness, training and consistent review of epilepsy knowledge and protocols.

The guidelines replace the Joint Epilepsy Council (JEC) guidelines on the use of buccal midazolam.

Expert comment

Consultant nurse for epilepsies Erica ChisangaErica Chisanga is a consultant nurse for epilepsies at Cambridge University Hospitals NHS Foundation Trust

‘Epilepsy can be life-changing and the psychosocial impact should not be underestimated. This guidance promotes early intervention in the event of prolonged seizures so that we minimise the impact of the condition on someone’s life and employment.

‘This guidance stresses that using buccal midazolam can significantly reduce co-morbidity and the risk of death from uncontrolled, prolonged seizures. Patients can have prolonged seizures managed in the community and thus avoid the distress inherent in emergency admission to hospital.

‘Community nurses need to identify those patients in their care who are at risk of having or are experiencing prolonged seizures but are not receiving buccal midazolam.

‘They should improve the communication between patients and their GPs or epilepsy specialist so that appropriate interventions can be put in place.

Nurses and other care support staff in the community need to receive appropriate and fairly extensive training in the management of epilepsy in general and specifically when a prolonged seizure ensues.’

Key points for nurses

  • One of the most important components of epilepsy care is the pre-hospital community management of prolonged or repeated seizures, which if untreated can increase the risk of status epilepticus, or prolonged seizures.
  • Convulsive status epilepticus is a medical emergency requiring admission to hospital and has a mortality rate of up to 20%.
  • The use of rescue medication by trained carers at the right time for the right purpose can significantly improve outcomes, reducing the risk of hospital admission and the mortality associated with convulsive status epilepticus.
  • Professional carers with responsibility for administering buccal midazolam should receive training updates once every two years for epilepsy awareness and administration of buccal midazolam.
  • Patients, families and carers of people with epilepsy should have the opportunity to be involved, as far as is practicable, in the development of their buccal midazolam care plan.

Erin Dean is a health journalist

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