Abstract
<title>Abstract</title> <p> <bold>Background</bold> Status epilepticus (SE) is a common neurological emergency and an important cause of morbidity and mortality among people with epilepsy, with a disproportionate burden in low- and middle-income countries. Across Africa, the diagnosis and management of SE are constrained by limited and inconsistent access to antiseizure medications (ASMs), electroencephalography (EEG), specialist clinicians, and critical care. Existing international guidelines have largely been developed based on evidence from high-income settings and may therefore be difficult to implement in many African health systems. Previous work by our group identified substantial heterogeneity in the management of SE in resource-limited settings, with strong support among clinicians for context-specific guidance. No continent-wide consensus framework currently exists for the diagnosis and management of convulsive SE in Africa. <bold>Methods</bold> This protocol describes a minimal-risk, multinational, modified Delphi consensus study that will be conducted electronically in three phases. In phase one, a core steering committee of six clinicians and scientists with expertise in SE, epilepsy, emergency medicine, critical care and consensus methodology will define the scope of the study and develop candidate statements informed by a systematic review, an international expert survey, and relevant clinical guidelines. In phase two, approximately 40 to 60 healthcare professionals involved in the management of convulsive SE in African settings will be recruited through six professional societies and local networks. Panellists will be selected using prespecified clinical and professional experience criteria while ensuring broad geographical and disciplinary representation. In phase 3, the expert panel will participate in a maximum of four electronic voting rounds. Multiple-choice items will achieve consensus when more than 75% of panellists select a single option. Statements rated on a 7-point Likert scale will achieve consensus for appropriateness or inappropriateness when at least 80% of panellists score within the agreement or disagreement band, respectively. Anonymised group-level feedback will be provided between rounds. Response stability will be assessed only for statements presented unchanged in consecutive rounds, and a statement will be finalised only when both prespecified consensus threshold and stability criteria have been satisfied. Analyses will be primarily descriptive. <bold>Discussion</bold> This study will establish the first continent-wide expert consensus on the diagnosis and management of convulsive status epilepticus in African clinical settings. The resulting consensus statements are intended to support more consistent and contextually appropriate clinical decision-making across diverse healthcare settings, inform education and training initiatives, and identify priorities for future research and guideline development. The protocol has been registered, and the completed study will be conducted and reported in accordance with established methodological recommendations for Delphi studies, including the CREDES guidance. <bold>Study Registration</bold> The design, hypotheses, and analysis plan for this study were preregistered on the Open Science Framework and can be accessed at 10.17605/OSF.IO/TZKAE. </p>