Lorazepam timing for acute convulsive seizure control (LoTASC)

Area of Science:

• Neurology
• Emergency Medicine
• Clinical Pharmacology

Background:

• Guidelines recommend early benzodiazepine (BZD) use for convulsive status epilepticus.
• Misinterpreting seizure duration can lead to premature BZD administration.
• Early BZD use may theoretically cause patient vital instability.

Purpose of the Study:

• To assess if lorazepam administration for convulsive seizures lasting less than five minutes causes vital instability.
• To evaluate the impact of early lorazepam on patient outcomes.

Main Methods:

• Retrospective study of patients with seizures <5 minutes (2011-2016).
• Analysis of lorazepam recipients versus non-recipients using t-test, Mann-Whitney U, and Chi-Square tests.
• Univariate and multivariate regression models to identify predictors of vital instability.

Main Results:

• 165 patients included; 91 received lorazepam.
• Lorazepam use was associated with significantly higher vital instability (OR=6.76, p=0.014).
• Vital instability was dose-dependent (p<0.0001) and lorazepam prolonged ICU length of stay (p=0.038).

Conclusions:

• Lorazepam for seizures not meeting status epilepticus criteria may cause iatrogenic vital instability.
• Early lorazepam administration is linked to increased ICU admission and stay.
• This highlights potential risks of early benzodiazepine use in seizure management.