Evaluation of Benzodiazepine Dosing in Status Epilepticus and Utilization of Adjunctive Treatments

Status epilepticus (SE) is a life-threatening neurologic emergency defined as a seizure with ≥5 minutes of continuous clinical and/or electrographic seizure activity or recurrent seizures without recovery. The Neurocritical Care Society and American Epilepsy Society recommend specific weight-based benzodiazepine (BZD) doses as the preferred initial treatment for SE. However, observational studies have demonstrated a trend of poor adherence to guideline-recommended (GR) BZD dosing. Less than guideline-recommended (

This is a single-center, retrospective cohort study of adult patients who were identified via ICD-10 codes for generalized convulsive SE and received initial treatment with a BZD in the ED between 2018 and 2025. Patients were divided into two cohorts based on the BZD dose administered in the ED: GR doses and

Eighty-one patients were selected for data collection. The mean age was 54 years and 59% were male. There were 50 administrations of lorazepam and 31 administrations of midazolam of which 29 (58%) and 5 (16%) were GR, respectively. Patients who received a GR BZD dose received significantly fewer second-line and third-line AEDs (p=0.012). Adverse effects, hospital length of stay, and in-hospital mortality were not significantly different between groups.

Guideline-recommend dosing of BZDs for SE in the ED was associated with the utilization of significantly fewer second-line and third-line AEDs.