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. 2025 Jun 10;104(11):e213689.
doi: 10.1212/WNL.0000000000213689. Epub 2025 May 16.

Status Epilepticus Protocol Variation Across Accredited National Association of Epilepsy Centers Members

Laura K Lamberta  1 , Melissa Asmar  2 , Megan M Fredwall  1 , Stephanie M Ahrens  1 , Shasha Bai  3 , Mariah Eisner  4 , Fred Alexander Lado  5 , Stephan U Schuele  6 , Dave F Clarke  7 , Ahmed T Abdelmoity  8 , Kathryn A Davis  9 , Jennifer L Hopp  10 , Mohamad Z Koubeissi  11 , Meriem K Bensalem Owen  12 , Susan T Herman  13 , Adam P Ostendorf  1 ; NAEC Center Director Study Group
Collaborators, Affiliations

Status Epilepticus Protocol Variation Across Accredited National Association of Epilepsy Centers Members

Laura K Lamberta et al. Neurology. .

Abstract

Objectives: Status epilepticus (SE) is a neurologic emergency that requires urgent recognition and medical management. SE management remains heterogeneous across centers.

Methods: We analyzed SE treatment protocols from level 3 and level 4 epilepsy centers. Discrete data including stabilization measures, timing of treatment phases, medications, doses, and routes of administration were collected from each protocol and described using frequency for categorical variables and median for continuous variables. The distribution of treatment times and dosing were compared with the AES guideline.

Results: A total of 256 SE treatment protocols were included. Only 66% of SE protocols detailed treatment times. Doses below recommendations occurred in 4% of protocols for initial benzodiazepine (BZD) and 14% for first non-BZD medications. Infusion therapy was outlined in 61% of protocols.

Discussion: Despite the importance of timeliness in SE management, one third of institutional protocols did not specify treatment times. This analysis of US hospital inpatient SE protocols provides expert opinion regarding infusion therapy management and highlights gaps and targets for improvement in SE treatment.

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Conflict of interest statement

The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Figures

Figure 1
Figure 1. Institutional Goal Status Epilepticus Treatment Times Across 3 Therapeutic Phases
Figure 2
Figure 2. Median Status Epilepticus Protocol Medication Dosing for Each Management Phase
BZD = benzodiazepine; DZP = diazepam; fosPHT = fosphenytoin; IM = intramuscular; IN = intranasal; IV = intravenous; LCS = lacosamide; LEV = levetiracetam; LZP = lorazepam; max = maximum; MDZ = midazolam; PHB = phenobarbital; PR = per rectal; VPA = valproic acid.
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