June 17, 2021

Status Epilepticus: Practice Variation and Adherence to Treatment Guideline in a Large Community Hospital

Abstract, published in Journal of Neurological Sciences

Purpose: To evaluate the treatment of status epilepticus (SE) and adherence to treatment guideline in a large Finnish community hospital.

Materials and methods: A consecutive series of 137 patients treated in the emergency department of Kuopio University Hospital. Enrollment took place between March 23 and December 31, 2015. Pediatric patients and postanoxic seizures were excluded. The Finnish Status Epilepticus Current Care Guideline was used as the evaluation benchmark.

Results: Seventeen patients recovered spontaneously. First-line treatment was given to 108 patients with 35.2% efficacy. Second-line treatment was given to 81 patients with 87.7% efficacy. Six patients with refractory SE received successful third-line treatment and four were excluded from intensive care because of futility. The starting dose of a first-line drug was lower than the lowest therapeutic dose in 37.0% of the patients. The escalation from first- to second-line treatment took longer than 60?min in 55.1% of the 70 patients who received both treatments. The first loading dose of a second-line drug was markedly low (<80% of the recommended dose) in 26.2% of the 81 patients treated with second-line drugs.

Conclusions: Prompt and effective pharmacotherapy is the cornerstone of good status epilepticus treatment. Subtherapeutic doses of first-line benzodiazepines should be avoided. Benzodiazepine-resistant status epilepticus must be recognized early to facilitate rapid treatment escalation. The quality of second-line treatment suffers from excessive delays and inadequate weight-based dosing of anti-seizure medications.

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