Abstract
Background Convulsive status epilepticus is a medical emergency requiring prompt evaluation and management. There exist published protocols to guide such treatment, including dosing requirements for first- and second-line antiseizure medications. The extent to which these recommendations are followed in South Australia are uncertain.
Methods A South Australian state-wide retrospective cohort study was conducted for convulsive status epilepticus cases admitted under neurology between 1st April to 1st July 2023. Automatic data collection and manual case note review was performed, particularly focusing on the types of antiseizure medications administered and its dosing.
Results During this period, there were 21 documented status epileptic cases. The first antiseizure medication administered include midazolam (n=15), levetiracetam (n=5), and propofol (n=1). The second antiseizure medications administered include levetiracetam (n=10), midazolam (n=3), propofol (n=1), valproate (n=1). The average first dose of midazolam administered was 4.84mg, and the average first dose of levetiracetam administered was 2275mg (32.36mg/kg). In several cases, there was delayed administration of a second antiseizure medication following midazolam in the setting of ongoing seizures.
Conclusion This study demonstrated that, in South Australia, published protocols for convulsive status epilepticus were not always adhered to. There were instances in which levetiracetam was used prior to benzodiazepines, and medications were administered below recommended dosing levels. Additional research is required to investigate strategies by which to promote adherence to evidence-based protocols in emergency situations.
