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

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.

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).

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.