This video was supported by Neuraxpharm

In this expert video, Professor Matthew Walker (UCL Queen’s Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London) provides a comprehensive overview of prolonged seizures and the prevention of status epilepticus.

Drawing on decades of clinical and research experience in drug-resistant epilepsy, Prof. Walker explains why defining a “prolonged seizure” is critical to determining when rescue medication should be administered. He outlines practical time thresholds for tonic–clonic and focal seizures, discusses seizure clusters, and highlights the mechanisms that allow seizures to progress when inhibitory pathways fail.

The video explores:

• When a seizure should be considered prolonged

• Which patients are at highest risk of status epilepticus

• The overwhelming evidence supporting early benzodiazepine use

• The importance of clear, written rescue medication plans

• Practical considerations around buccal, nasal, rectal, and intravenous routes

• Common barriers to timely treatment, including lack of education and confidence

Prof. Walker also addresses the serious morbidity and mortality associated with status epilepticus and emphasises the need for early, adequate, and rapid intervention to prevent progression to refractory status.

A highly practical and clinically focused discussion for neurologists, epilepsy specialists, nurses, and healthcare professionals involved in seizure management — reinforcing the central message: act early, treat adequately, and ensure every patient has a clear rescue plan in place.