Adequate and inadequate dosing of anti-seizure medications in status epilepticus.

BACKGROUND

Status epilepticus (SE) is defined as five or more minutes of continuous seizures or two or more discrete seizures with incomplete recovery of consciousness.1 The incidence of SE in the United States ranges from 18.3 to 41 per 100,000 patients per year2. Reviews of SE clinical literature demonstrate that 70-75 % of patients did not receive an adequate dose of benzodiazepine according to clinical guidelines. Underdosing of benzodiazepines increases the risk of refractory SE and unfavorable outcomes.8-9

METHODS

This single center retrospective cohort study evaluated the dosing of benzodiazepines and other anti-seizure medications in adult patients with SE. The primary outcomes were incidence of breakthrough seizures in patients with appropriate dosing benzodiazepines compared to inappropriate dosing of benzodiazepines within 24 h of the first dose and incidence of breakthrough seizures in patients with appropriate loading dose of maintenance anti-seizure medication compared to inappropriate loading dose of anti-seizure medication within 24 h of the first dose.

RESULTS

Thirty-eight patients received adequate benzodiazepine dosing compared to 155 with inadequate dosing. Eighty-seven percent of patients with adequate dosing of benzodiazepine experienced a breakthrough seizure compared to 84 % of patients with inadequate dosing (p = 0.62). Sixty-three percent of patients with adequate dosing of benzodiazepines required first non-benzodiazepine anti-seizure medication compared to 63 % of patients with inadequate dosing (p = 0.76). Breakthrough seizures within 24 h after the first load of non-benzodiazepine anti-seizure medication occurred in 21 % of patients in the adequate dosing group compared to 28 % in the inadequate dosing group (p = 0.73).

CONCLUSION

While benzodiazepines and rescue anti-seizure medications are frequently underdosed in patients with status epilepticus, there was no difference in recurrent seizures comparted to those with adequate dosing.