Status Epilepticus Management in Resource-Limited Settings: An International Expert Survey.

Area of Science:

• Neurology
• Global Health
• Clinical Practice Guidelines

Background:

• Status epilepticus (SE) presents significant mortality and morbidity, particularly in low- and middle-income countries.
• Existing SE management guidelines are often based on high-income country contexts, posing challenges for resource-limited settings.
• Barriers include diagnostic, therapeutic, and infrastructural constraints specific to these regions.

Purpose of the Study:

• To examine expert clinician perspectives on SE management in resource-limited settings.
• To identify common barriers hindering effective SE care.
• To explore context-specific strategies for improving SE management.

Main Methods:

• Convergent parallel mixed methods approach utilizing quantitative and qualitative data.
• Online survey distributed to purposively sampled SE management experts.
• Expert participants balanced clinical expertise across neurology, emergency medicine, and critical care, and represented diverse geographic locations.

Main Results:

• 28 experts from 15 countries participated, with over 96% emphasizing the need for SE guidelines applicable to resource-limited settings.
• Key barriers identified include inadequate SE education and limited access to anti-seizure medications (ASMs); 86% advocated for oral ASMs in guidelines.
• Access to electroencephalography (EEG) was inconsistent (39%), with limited consensus on EEG protocols. Multicenter international efforts were deemed essential.

Conclusions:

• Expert insights reveal systemic barriers to SE care in resource-limited settings that extend beyond clinical decision-making.
• There is an urgent need for inclusive, context-sensitive frameworks and implementation strategies for SE management.
• Findings offer expert-informed priorities for future policy, research, and clinical practice to achieve equitable SE care.