Swift Action: The Importance of Rapid and Early Seizure Termination (REST)

This month we’re both excited and honoured to be participating in and supporting the 9th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures, as well as presenting the latest data from our diverse epilepsy portfolio at the 2024 Annual Meeting of the American Academy of Neurology.

A key focus of our discussions will be the recent advancements in how we understand and manage prolonged seizures, with a crucial goal to prevent their progression to seizure emergencies, such as status epilepticus (SE). So, what do we mean by prolonged seizures?

Most epileptic seizures will terminate within two minutes and, therefore, may not require intervention with medication. However, seizures that do not self-terminate can progress into a seizure emergency, such as a prolonged seizure, and potentially into SE (defined as a seizure lasting ≥5 minutes for convulsive SE​ or ≥10–15 minutes for ​non-convulsive SE)​ if left untreated.  

Why do Prolonged Seizures matter?

Prolonged seizures are more than just extended epileptic events – they represent a complex challenge that can result in significant physical, psychological, cognitive, and socioeconomic burdens for patients, caregivers and healthcare systems.

• Potential modification of synapse function can occur within minutes
• An increased risk of evolving into more severe seizure types, which are associated with serious consequences
• Increased risk of physical injury 

Should a prolonged seizure advance to status epilepticus, consequences can include:  

• Increased risk of death
• Brain injury including neuronal damage
• Reduced QoL and societal impacts
• Healthcare resource utilization and costs

In light of these considerations, it is surprising that no standardized definition of a prolonged seizure exists, which hampers our ability to manage them effectively. However, an expert working group is hoping to change this, proposing a new way forward.

The Seizure Termination Project

The Seizure Termination Project – a world-renowned expert working group comprising 12 epileptologists, neurologists and pharmacologists from Europe and North America – was formed in 2022 to help reach consensus on the definitions of prolonged seizures and seizure clusters, and treatment goals to prevent progression to a seizure emergency, setting the stage for improved treatment strategies.

Supported by UCB, the expert group has recommended new terminology that will support more consistent description and tracking of epileptic episodes across the globe. The new terminology includes:

• prolonged seizures: proposed thresholds of 5 minutes for prolonged focal seizures and 2 minutes for prolonged absence seizures and the convulsive phase of bilateral tonic–clonic seizures
• seizure clusters: abnormal increase in seizure frequency compared with the individual patient’s usual seizure pattern.  
• Rapid and Early Seizure Termination (REST): a new management paradigm that encompasses the acute treatment of ongoing seizures  

This new terminology complements existing guidance on managing acute seizures, offering a more robust and uniform framework for patient identification and advancement in treatment. By providing a clearer picture of what constitutes a prolonged seizure, the expert group hopes to facilitate better patient management, with the possibility of treating earlier to potentially avoid progression to a seizure emergency, ultimately improving clinical outcomes and reducing healthcare resource utilization.

Please note, this post is for professional discussion and the information contained is based on theoretical therapeutic approaches. Always consult healthcare professionals for medical advice.