Breaking the seizure cycle: Belgian expert consensus on the diagnostics and treatment of acute convulsive seizures in children

INTRODUCTION: Seizures are the most common neurological emergency in children. Heterogeneous causes, subtypes, and varying treatment responses make seizures a complex and often unpredictable challenge for clinicians. The management of acute seizures in children, particularly in the outpatient setting, received relatively limited attention in international treatment guidelines. Prompt and proper management in the acute setting, may prevent hospitalization as well as long-term neurological and developmental consequences. METHODS: An expert consensus panel was convened to develop comprehensive and practical guidance for the early recognition, diagnostic evaluation, and management of acute convulsive seizures in children and adolescents. Recommendations were formulated through a structured review of the most recent scientific literature, current clinical guidelines, and expert opinion. Emphasis was placed on generating clear, actionable recommendations to support healthcare professionals in the rapid identification and effective treatment of acute convulsive seizures in pediatric populations. RESULTS: This report specifically focuses on the first 5-10 min from seizure onset, which usually corresponds to the outpatient setting, including the initial steps of the inpatient treatment pathway for acute convulsive seizures in children and adolescents. CONCLUSIONS: This expert review provides actionable insights for healthcare professionals managing pediatric seizures, emphasizing the importance of a rapid and effective treatment for acute convulsive seizures.