Towards a Consensus Framework for the Diagnosis and Management of Convulsive Status Epilepticus in Africa: A Modified Delphi Study

Status epilepticus (SE) is a major neurological emergency associated with substantial morbidity and mortality, particularly when treatment is delayed or ineffective. Although several international guidelines provide recommendations for the diagnosis and management of convulsive status epilepticus, much of the evidence informing these guidelines originates from high-income settings. Their implementation in African healthcare systems may be limited by differences in access to medications, diagnostic investigations, specialist expertise, critical care facilities, emergency medical services, and other healthcare resources. There is therefore a need for contextually appropriate recommendations that reflect both the available evidence and the practical realities of managing status epilepticus across diverse African healthcare settings. The purpose of this study is to develop expert consensus on the diagnosis and management of convulsive status epilepticus in Africa using a modified Delphi methodology. The study will bring together clinicians with relevant expertise and experience in the management of status epilepticus across African settings, including specialists in neurology, emergency medicine, critical care, and related disciplines. By incorporating perspectives from clinicians practising across different countries, healthcare systems, disciplines, and resource settings, the study aims to identify areas of agreement regarding clinically important aspects of the recognition, investigation, acute treatment, escalation of therapy, monitoring, and ongoing management of convulsive status epilepticus. The study will use a structured, iterative Delphi process conducted electronically. Candidate statements will be developed from existing evidence, international guidance, and issues relevant to the African clinical context. Participating experts will independently rate these statements over successive Delphi rounds using predefined response scales and consensus criteria. Following each round, responses will be analysed in aggregate and participants will receive structured feedback regarding the distribution of panel responses. Statements that do not meet the predefined criteria for consensus may be revised, reconsidered, or removed in accordance with the study protocol. Where appropriate, participants will also have opportunities to provide comments or suggest modifications to statements. This iterative process is intended to allow participants to reconsider their responses in light of anonymised group feedback while minimising the influence of dominant individuals and preserving independent expert judgement. Participant characteristics, including clinical specialty, country of practice, years of professional experience, and relevant experience within the expert panel, will be summarised descriptively. Responses to Delphi statements will be analysed using predefined consensus criteria, with results reported at an aggregate level. The study is intended to evaluate the extent of expert agreement rather than to test a clinical intervention or estimate treatment efficacy. The primary expected outcome is a set of consensus-based statements addressing the diagnosis and management of convulsive status epilepticus that are relevant and applicable to African healthcare settings. The study is also expected to identify areas in which expert agreement cannot be achieved. These areas of uncertainty or disagreement may be particularly informative, as they may highlight limitations in the existing evidence base, differences in practice across settings, or topics requiring further clinical research. Ultimately, the study aims to provide a pragmatic and contextually relevant consensus framework that can contribute to the future development or adaptation of African guidance for convulsive status epilepticus. The findings may also support clinical education, facilitate greater consistency in practice where appropriate, identify priorities for future research, and provide a foundation for subsequent guideline-development initiatives. The resulting consensus statements are not intended to replace individual clinical judgement or existing national guidance, but rather to provide an expert-informed framework reflecting the circumstances, challenges, and priorities associated with the management of convulsive status epilepticus across the African continent.