The Epilepsy Specialist Nurses Association (ESNA) has published a major revision of its Best Practice Guidelines for Professional Carers in Emergency Seizure Medication, representing the most collaborative review in the history of the document.

The updated guidance has been developed through a six-month national review involving epilepsy specialist nurses, pharmacists, educationalists, training providers, governance specialists, care providers, charities and experts from across the UK and Ireland.

More than 40 contributors from over 30 organisations participated in the review, bringing together perspectives from clinical practice, social care, education, research and lived experience. Contributors included representatives from ESNA, Epilepsy Action, Epilepsy Society, Epilepsy Ireland, Epilepsy Wales, Young Epilepsy, Quarriers, NHS organisations, universities and specialist training providers.

The review was led by Caryn Jory, Lead Epilepsy Specialist Nurse and Vice Chair of ESNA; Deborah Coker, Lead Epilepsy Specialist Nurse and Secretary of ESNA; Sally-Ann Remnant, Clinical Nurse Specialist in Epilepsy; and Fiona Short, Roald Dahl Epilepsy Specialist Nurse for Complex Epilepsy and Transition.

Unlike previous editions, which were developed primarily within the epilepsy nursing profession, the 2026 review adopted a structured consensus approach, using consultation exercises, expert discussion groups, Delphi-style questions, stakeholder meetings and written submissions to explore areas of agreement and challenge assumptions.

Caryn Jory, Lead Author and Vice Chair of ESNA, said:

“This review recognised that safe emergency seizure medication practice sits at the intersection of clinical expertise, education, governance, social care and lived experience. We wanted to ensure that all of those perspectives had a voice. The result is guidance that is not only evidence-informed but grounded in the realities of practice.”

The updated guidelines reflect developments in evidence, learning from national reviews and the increasing complexity of epilepsy care in community settings. The review considered findings from contemporary research alongside lessons from LeDeR reports, the REMIT study and wider national work aimed at improving outcomes for people living with epilepsy.

Key developments within the revised guidance include:

• Clearer standards for initial and refresher training in emergency seizure medication administration.

• Enhanced expectations around competency assessment and ongoing assurance of practice.

• Stronger guidance on trainer competencies, governance arrangements and quality assurance.

• Defined standards for virtual and blended learning where these approaches are used.

• Greater emphasis on accountability, documentation and organisational oversight.

• Updated supporting guidance for specialist and exceptional circumstances.

The review was supported by Professor Rohit Shankar MBE FRCPsych, Professor in Neuropsychiatry at the University of Plymouth and a nationally recognised expert in epilepsy care.

Professor Shankar said:

“One of the strengths of this review has been its willingness to bring together diverse perspectives in pursuit of a shared goal: safer, more consistent care for people living with epilepsy. Consensus guidance is strongest when it reflects both evidence and real-world experience.”

The revised ESNA Best Practice Guidelines are intended to support healthcare professionals, social care providers, training organisations and commissioners in delivering safe, high-quality emergency seizure medication practice across community settings.