Status epilepticus and benzodiazepine treatment: Use, underdosing and outcome-insights from a retrospective, multicentre registry

Objective: To explore the reasons for and outcomes of non- or undertreatment with benzodiazepines (BZDs) in status epilepticus (SE). Methods: We retrospectively analysed all SE patients from the urban area of Cologne over two years. Results: 328 SE patients were eligible, and only 72% were initially treated with BZDs. Of these, only 21.6% were treated sufficiently with BZDs according to current guidelines. SE patients not initially treated with BZDs were significantly older, had less often known epilepsy, had a prolonged arrival time to the emergency room, and presented more often with a non-generalised convulsive semiology. Regarding adequate dosages, patients with a generalised convulsive SE seemed to benefit from a sufficient BZD dosing with significantly shortened mean ventilation duration (37.1 to 208 h), decreased mean intensive care unit (1.7 to 5 days) and in-hospital stay (4.1 to 8.8 days). In contrary, aggressive BZD treatment in non-generalised convulsive SE resulted in a longer inpatient stay (9.2 to 5.8 days) and lower favourable outcome rates at discharge (16% to 63%). Conclusions: The current SE treatment guidelines for first-line BZD therapy in SE were violated in most patients. Sufficient BZD dosing was beneficial in generalised convulsive SE, but not in other forms of SE. SE semiology might be crucial for treatment decisions with BZDs. Further treatment evidence especially in non-generalised convulsive SE is urgently needed.

Automated summary

This study revealed that most patients with status epilepticus (SE) were not effectively treated with benzodiazepines (BZDs) according to current guidelines. Sufficient dosing of BZDs was found to be beneficial for patients with generalised convulsive SE, but not for other types of SE. Treatment decisions guided by the semiology of SE are crucial, and further evidence is urgently needed for the management of non-generalised convulsive SE.