Implementation of the Seizure Code for urgent epilepsy care in Spain: a comprehensive clinical protocol

Epilepsy is a significant public health concern in Spain, with an estimated prevalence of 578,000 patients and a substantial burden on emergency services. Urgent epileptic seizures (particularly status epilepticus) are associated with high morbidity and mortality, requiring rapid and coordinated interventions. The objective was to analyze the implementation of the Seizure Code, a pioneering and comprehensive clinical protocol for urgent epilepsy care in Spain, describing its structure, activation criteria, and preliminary outcomes. We review the multilevel structure of the Seizure Code implemented in the Madrid region, which coordinates care from prehospital settings to intensive care units. Comparative analysis is included of other national initiatives such as the Epilepsy Care Plan in the Valencian Community and the Epi-Ruta project in Andalusia. The Seizure Code defines clear activation criteria and critical intervention timeframes, incorporating therapeutic algorithms and early diagnostic tools, including urgent video-EEG. Its implementation in Madrid has involved 10 hospitals and over 100 healthcare professionals, resulting in reduced treatment times and improved clinical outcomes, with over 1,400 activations recorded in 2024. Scientific evidence supports improvements in mortality, seizure recurrence, and healthcare efficiency following protocol adoption. The Seizure Code represents an innovative and scalable model for urgent epilepsy care, enhancing care coordination and clinical outcomes. Its development lays the groundwork for nationwide expansion and the evaluation of its impact on care quality and cost-effectiveness.