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

Laura K. Lamberta, Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH.
Melissa Asmar, Department of Neurology, University of California Davis, Sacramento, CA.
Megan M. Fredwall, Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH.
Stephanie M. Ahrens, Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH.
Shasha Bai, Pediatrics Biostatistics Core, Emory University School of Medicine, Atlanta, GA.
Mariah Eisner, Biostatics Resource, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH.
Fred Alexander Lado, Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
Stephan U. Schuele, Department of Neurology, Feinberg School of Medicine Northwestern Memorial Hospital, Chicago, IL.
Dave F. Clarke, Department of Neurology, Dell Medical School, University of Texas at Austin, TX.
Ahmed T. Abdelmoity, Division of Neurology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.
Kathryn A. Davis, Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
Jennifer L. Hopp, Neurology, University of Maryland Medical Center, Baltimore, MD.
Mohamad Z. Koubeissi, Department of Neurology, George Washington University, Washington, DC.
Meriem K. Bensalem Owen, Department of Neurology, University of Kentucky College of Medicine, Lexington, KY; and.
Susan T. Herman, Barrow Neurological Institute, Phoenix, AZ.
Adam P. Ostendorf, Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH.

Document Type

Journal Article

Publication Date

6-10-2025

Journal

Neurology

Volume

104

Issue

11

DOI

10.1212/WNL.0000000000213689

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.

Department

Neurology

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