"Epileptic seizure code in the region of Madrid": A process-based healthcare network for the acute management of epileptic seizures.
Epilepsia open · 2025-11-18 · Implementation & quality improvement
Abstract
The principle "time is brain" applies to epileptic seizures as well as stroke. Despite existing guidelines, delays in treatment initiation remain common. In 2020, we developed a consensus statement aiming to improve the acute management of emergency seizures and implement a "Seizure Code" (SC) in Madrid, Spain. A multidisciplinary group of 105 professionals from 27 hospitals across the Madrid regional health service collaborated to design a structured healthcare process for emergency seizure care. This included seven key subprocesses: pre-hospital care, SC activation, emergency department management, hospital ward care, referral to specialized centers, intensive care units (ICUs) treatment, and discharge planning with follow-up. Three additional cross-cutting areas-training, research, and quality control-were included to ensure continuous improvement. Ten coordinators oversaw protocol development and standardization. The plan emphasized education for families and caregivers, standardized transfer pathways, and unified pre- and in-hospital treatment across all ages. Implementation began in November 2021, with official approval in August 2022. The SC protocol was formally launched on November 15, 2023. Over 200 patients meeting SC criteria have since been registered and monitored. The coordinated effort has led to the region-wide implementation of the SC. The next step is to evaluate its impact on emergency seizure management and patient outcomes. PLAIN LANGUAGE SUMMARY: Although time is crucial in epilepsy management, there are still gaps in care that lead to delays in treating these patients. To improve this, we have developed a Process-Based Healthcare Network for the acute management of epileptic seizures, which includes the implementation of a SC. Our goal is to better organize care across different levels of the healthcare system, facilitate therapeutic decision-making, and improve response times and patient outcomes. Here, we present the development and implementation of this care pathway designed to enhance coordination and efficiency in the management of urgent epileptic seizures.