OBJECTIVE Although the initial treatment of childhood seizures is important, treatment within an appropriate time window is often difficult in resource-limited areas. This study examined childhood seizure treatment in a rural area in Japan. METHODS We retrospectively investigated children presenting to Nakatsugawa Municipal General Hospital emergency department between 2015 and 2018. From the hospital database, we identified children who were diagnosed with seizures, epilepsy, or acute infectious encephalitis/encephalopathy or were given benzodiazepines. We considered etiology, seizure duration, and treatment according to the specialties of the doctors providing initial care. RESULTS We extracted 236 seizure events: 40 initially treated by pediatricians, 16 by a mobile doctor team, and 180 by other doctors. Twenty patients had continuous seizures for longer than 5 min on admission. Two were treated by pediatricians at presentation; it took 4 and 7 min after arrival to stop the seizures. Four were treated by a mobile team, and 14 by other doctors; the median response times were 11.5 (range 3-47) and 19 (range 5-60) min, respectively. All patients treated by pediatricians or mobile doctor teams received intravenous or intramuscular diazepam, whereas 50% of those treated by other doctors initially received diazepam suppositories. In three of the 20 events, establishing intravenous access was difficult. SIGNIFICANCE In rural Japan, many children with seizures are initially treated by doctors other than pediatricians or emergency physicians, and they require a longer time to achieve seizure cessation. Non-intravenous benzodiazepine formulas, which have not yet been approved in Japan, would be helpful.

中文翻译：

---

日本农村急诊科儿童癫痫发作的初步治疗

目标 虽然儿童癫痫的初始治疗很重要，但在资源有限的地区，在适当的时间范围内进行治疗通常很困难。本研究调查了日本农村地区的儿童癫痫治疗。方法 我们回顾性调查了 2015 年至 2018 年期间就诊于中津川市综合医院急诊科的儿童。从医院数据库中，我们确定了被诊断为癫痫发作、癫痫或急性传染性脑炎/脑病或接受苯二氮卓类药物治疗的儿童。我们根据提供初始护理的医生的专长考虑了病因、癫痫发作持续时间和治疗方法。结果 我们提取了 236 个癫痫事件：40 个最初由儿科医生治疗，16 个由流动医生团队治疗，180 个由其他医生治疗。20 名患者在入院时连续癫痫发作超过 5 分钟。其中两人在就诊时接受了儿科医生的治疗；到达后需要 4 和 7 分钟才能停止癫痫发作。4 人由流动小组治疗，14 人由其他医生治疗；中位响应时间分别为 11.5（范围 3-47）和 19（范围 5-60）分钟。由儿科医生或流动医生团队治疗的所有患者都接受了静脉注射或肌肉注射地西泮，而其他医生治疗的患者中有 50% 最初接受了地西泮栓剂。在 20 起事件中的 3 起，建立静脉通路很困难。意义在日本农村，许多癫痫儿童最初由儿科医生或急诊医生以外的医生治疗，他们需要更长的时间才能停止癫痫发作。非静脉内苯二氮卓配方，