Acutely terminating seizures often puts us in a dilemma; too little and underdose, or too much and toxicities. Working along this spectrum requires a general understanding of the guidelines recommendations. It'll also be good for you to understand benzodiazepine pharmacokinetics. Let's review initial benzodiazepine dosing in the treatment of status epilepticus (SE)!
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References
Lee, S. Diagnosis and Treatment of Status Epilepticus. J Epilepsy Res. 2020 Dec 31;10(2):45-54.
Kapur et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019 Nov 28;381(22):2103-2113.
Kohl et al. Status epilepticus and benzodiazepine treatment: Use, underdosing and outcome - insights from a retrospective, multicentre registry. Seizure. 2023 Apr;107:114-120. doi: 10.1016/j.seizure.2023.03.020.
Silbergleit et al. RAMPART (Rapid Anticonvulsant Medication Prior to Arrival Trial): a double-blind randomized clinical trial of the efficacy of intramuscular midazolam versus intravenous lorazepam in the prehospital treatment of status epilepticus by paramedics. Epilepsia . 2011 Oct;52 Suppl 8(Suppl 8):45-7.
Sathe et al. Underdosing of Benzodiazepines in Patients With Status Epilepticus Enrolled in Established Status Epilepticus Treatment Trial. Acad Emerg Med . 2019 Aug;26(8):940-943. Glauser et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016 Jan-Feb; 16(1): 48–61.
Leppik IE et al. Double-blind study of lorazepam and diazepam in status epilepticus. JAMA 1983;249:1452–1454.
Alldredge BK et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 2001;345:631–637.
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