The care given to 8 children with epilepsy admitted with convulsive status epilepticus during 1990 is evaluated at the University Hospital of Wales, Cardiff. All had significant learning disabilities. In 17 admissions, eye-witness accounts of the seizure leading to admission were not recorded in 5, and were poorly described in 11. Of 9 convulsive episodes persisting on admission, 6 had been treated with rectal diazepam in the home. All children were on maintenance therapy for previously diagnosed epilepsy, but only one was recorded as compliant. AED dosage was adjusted after 8 of the episodes, less than half the total. Prevention of further episodes after discharge was not considered in 8 cases. The availability of rectal diazepam in the home was ignored for most admissions, and parents had not been instructed in its optimal usage. Average length of stay was 2 days. [1]

COMMENT. The importance of epilepsy prevention is stressed both in the US and UK current literature. The release of excitotoxic amino acids such as glutamate and aspartate from discharging neurons, with further cerebral damage as a consequence of uncontrolled seizures is cited as a reason for optimal control. Neurological, psychological and social dysfunction resulting from poorly controlled epilepsy are additional reasons for closer attention to the prevention of seizures and their consequencies. The failure of rectal diazepam administered in the home in 6 patients admitted in status epilepticus might be explained by the inadequate instruction or compliance of parents.