rehospital Management of Seizures: Clinical Challenges, Common Errors and Current Evidence-Based Approaches.

Abstract

Background. Seizure syndrome is one of the most common neurological emergencies encountered by emergency medical service providers in the prehospital setting. Delayed recognition of seizure etiol-ogy, inappropriate management strategies, or untimely administration of anticonvulsant therapy may result in status epilepticus, secondary brain injury, respiratory failure, and poor clinical outcomes. The purpose was to summarize current evidence-based approaches to the diagnosis and emergency care of seizure syndrome in the prehospital setting, to analyze common management errors, and demonstrate the clinical importance of timely recognition of urgent neurological pathology using clinical case examples. Materials and methods. A narrative literature review was con-ducted using publications indexed in the PubMed database and contem-porary international guidelines on the management of seizures and status epilepticus in the prehospital setting. Evidence regarding the effectiveness of benzodiazepines as first-line therapy, features of initial patient assess-ment, and common errors when providing emergency care was analyzed. In addition, clinical cases of seizure syndrome associated with subarach-noid hemorrhage, metastatic brain disease, severe traumatic brain injury, and drug-resistant epilepsy were reviewed. Results. The literature analysis confirmed that effective seizure management is based on early seizure recognition, assessment of vital functions according to the ABCDE ap-proach, timely administration of benzodiazepines, and identification of potentially reversible causes of seizures. The most common management errors include delayed pharmacological treatment, underestimation of seizure duration, inadequate airway management, and insufficient atten-tion to the underlying etiology of seizures. The presented clinical cases demonstrate that seizures may be the first manifestation of severe neuro-surgical or oncological pathology and require urgent referral to a specia-lized medical center. Conclusions. Seizure syndrome in the prehospital setting requires rapid and evidence-based clinical decision-making. The use of standardized management algorithms, early administration of benzodiazepines, and timely recognition of urgent neurological condi-tions contribute to improved patient outcomes and reduced risk of severe complications.