ArticleEpilepsy & behavior reports2026
Evaluation of the appropriateness of pediatric seizure Management in Primary Care Clinics.
Article in Epilepsy & behavior reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Background: Effective management of any pediatric seizure event - not only febrile seizures - is a core requirement of pediatric primary care. In Japan, where the background prevalence of febrile seizures (FSs) is high (8-10% of children), pediatric primary care clinics may encounter status epilepticus (SE) requiring immediate antiseizure medication. Buccal midazolam was approved in Japan in December 2020. The pediatric rescue medication landscape in Japan differs substantially from many other countries: rectal diazepam gel is not approved, and intranasal diazepam was not yet on the market during the study period. To our knowledge, primary-care-level data on the incidence and management of in-clinic pediatric seizures in Japan remain limited. Methods: This multicenter retrospective observational study included pediatric patients (0-18 years) who experienced seizures during clinic visits at 32 primary care clinics in Japan between November 2023 and October 2024. Clinical data were extracted from electronic medical records. SE was defined as a generalized tonic-clonic seizure lasting ≥5 min. Statistical analyses included chi-square tests to assess the relationships between seizure onset time of day, monthly occurrence, and emergency transport. Among transported patients, the appropriateness of buccal midazolam administration was evaluated against pre-specified criteria based on the Japanese package insert. Results: Of 967,417 eligible pediatric outpatient visits (after exclusion of 191,009 visits by patients aged >18 years), 132 (0.014%) involved an in-clinic seizure. Of these, 52 (39.4%) required emergency transport. No significant differences were observed in seizure occurrence across time of day (χ Conclusions: Seizures in pediatric primary care occur sporadically and require continuous preparedness. Suboptimal management of SE, particularly delayed benzodiazepine administration and underutilization of buccal midazolam, was identified. Enhanced education focusing on SE recognition and appropriate medication use may improve the quality of seizure care in community pediatric settings.
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