Vincent Alvarez1,2,3,4, Jong Woo Lee1, Frank W Drislane3, M Brandon Westover2, Jan Novy5, Barbara A Dworetzky1, Andrea O Rossetti5. 1. Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A. 2. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A. 3. Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A. 4. Department of Neurology, Valais Hospital, Sion, Switzerland. 5. Department of Clinical Neurosciences, CHUV and University of Lausanne, Lausanne, Switzerland.
Abstract
OBJECTIVE: Benzodiazepines (BZD) are recommended as first-line treatment for status epilepticus (SE), with lorazepam (LZP) and midazolam (MDZ) being the most widely used drugs and part of current treatment guidelines. Clonazepam (CLZ) is also utilized in many countries; however, there is no systematic comparison of these agents for treatment of SE to date. METHODS: We identified all patients treated with CLZ, LZP, or MDZ as a first-line agent from a prospectively collected observational cohort of adult patients treated for SE in four tertiary care centers. Relative efficacies of CLZ, LZP, and MDZ were compared by assessing the risk of developing refractory SE and the number of antiseizure drugs (ASDs) required to control SE. RESULTS: Among 177 patients, 72 patients (40.62%) received CLZ, 82 patients (46.33%) LZP, and 23 (12.99%) MDZ; groups were similar in demographics and SE characteristics. Loading dose was considered insufficient in the majority of cases for LZP, with a similar rate (84%, 95%, and 87.5%) in the centers involved, and CLZ was used as recommended in 52% of patients. After adjustment for relevant variables, LZP was associated with an increased risk of refractoriness as compared to CLZ (odds ratio [OR] 6.4, 95% confidence interval [CI] 2.66-15.5) and with an increased number of ASDs needed for SE control (OR 4.35, 95% CI 1.8-10.49). SIGNIFICANCE: CLZ seems to be an effective alternative to LZP and MDZ. LZP is frequently underdosed in this setting. These findings are highly relevant, since they may impact daily practice. Wiley Periodicals, Inc.
OBJECTIVE:Benzodiazepines (BZD) are recommended as first-line treatment for status epilepticus (SE), with lorazepam (LZP) and midazolam (MDZ) being the most widely used drugs and part of current treatment guidelines. Clonazepam (CLZ) is also utilized in many countries; however, there is no systematic comparison of these agents for treatment of SE to date. METHODS: We identified all patients treated with CLZ, LZP, or MDZ as a first-line agent from a prospectively collected observational cohort of adult patients treated for SE in four tertiary care centers. Relative efficacies of CLZ, LZP, and MDZ were compared by assessing the risk of developing refractory SE and the number of antiseizure drugs (ASDs) required to control SE. RESULTS: Among 177 patients, 72 patients (40.62%) received CLZ, 82 patients (46.33%) LZP, and 23 (12.99%) MDZ; groups were similar in demographics and SE characteristics. Loading dose was considered insufficient in the majority of cases for LZP, with a similar rate (84%, 95%, and 87.5%) in the centers involved, and CLZ was used as recommended in 52% of patients. After adjustment for relevant variables, LZP was associated with an increased risk of refractoriness as compared to CLZ (odds ratio [OR] 6.4, 95% confidence interval [CI] 2.66-15.5) and with an increased number of ASDs needed for SE control (OR 4.35, 95% CI 1.8-10.49). SIGNIFICANCE: CLZ seems to be an effective alternative to LZP and MDZ. LZP is frequently underdosed in this setting. These findings are highly relevant, since they may impact daily practice. Wiley Periodicals, Inc.
Authors: Robert Silbergleit; Valerie Durkalski; Daniel Lowenstein; Robin Conwit; Arthur Pancioli; Yuko Palesch; William Barsan Journal: N Engl J Med Date: 2012-02-16 Impact factor: 91.245
Authors: Vincent Alvarez; Jong Woo Lee; M Brandon Westover; Frank W Drislane; Jan Novy; Mohamed Faouzi; Nicola A Marchi; Barbara A Dworetzky; Andrea O Rossetti Journal: Neurology Date: 2016-09-24 Impact factor: 9.910
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Authors: Abhishek G Sathe; Ellen Underwood; Lisa D Coles; Jordan J Elm; Robert Silbergleit; James M Chamberlain; Jaideep Kapur; Hannah R Cock; Nathan B Fountain; Shlomo Shinnar; Daniel H Lowenstein; Eric S Rosenthal; Robin A Conwit; Thomas P Bleck; James C Cloyd Journal: Epilepsia Date: 2021-02-10 Impact factor: 5.864