Pöytäkangas Teemu, Basnyat Pabitra, Rainesalo Sirpa, Peltola Jukka, Saarinen Jukka T
Department of Emergency Medicine, Vaasa Central Hospital, Vaasa, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Epilepsy Res. 2025 Feb;210:107507. doi: 10.1016/j.eplepsyres.2025.107507. Epub 2025 Jan 9.
Status epilepticus (SE) is a life-threatening state that needs rapid and adequate treatment. Benzodiazepines (BZD) are used as a first-line treatment for SE, and if the desired effect is not achieved, second-line antiseizure medications are used.
To investigate whether the treatment with BZDs is performed adequately in patients with different subtypes of SE requiring second-line ASM treatment and, if not, to identify the factors influencing the suboptimal treatment.
This is a retrospective single centre study from the patient register of Tampere University Hospital including patients over 16 years of age with a diagnosis of SE, seizure or epilepsy and who received intravenous (IV) ASM during a one-year period in 2015. Treatment was considered to be suboptimal if it was not in line with the latest European, Finnish or American guidelines.
In total, 109 episodes were registered. The largest group was that with convulsive SE with 56 episodes, followed by postictal with 23 episodes, nonconvulsive status epilepticus (NCSE) with 22 episodes, and focal awareness SE (FASE) with eight episodes. Overall, in 77 % of the episodes, BZDs were administered, and in 43 % of the episodes, treatment was in line with guidelines. In the NCSE group, BZD was administered less often and was less often in line with the guidelines than in the CSE group (27.3 % vs. 89.3 %, p < 0.001 and 4.5 % vs. 55.4 %, p < 0.001). For FASE episodes, the concordance with the guidelines was low. After IV administration, the mean BZD dose was lower than that after buccal administration of midazolam (2.1 mg vs. 8.7 mg) or after rectal administration of diazepam (4.5 mg vs. 10.0 mg). Lorazepam was administered only via the IV route, with mean dosage of 2.6 mg. Clinical characteristics did not influence the dosing of BZDs.
BZDs were both underdosed and underused for all subtypes of SE. In particular, their use for NCSE was infrequent and suboptimal. The divergence from the guidelines was influenced especially by low IV dosages.
癫痫持续状态（SE）是一种危及生命的状态，需要迅速且充分的治疗。苯二氮䓬类药物（BZD）被用作SE的一线治疗药物，如果未达到预期效果，则使用二线抗癫痫药物。
调查在需要二线抗癫痫药物治疗的不同亚型SE患者中，BZD治疗是否充分进行，若不充分，确定影响治疗效果欠佳的因素。
这是一项来自坦佩雷大学医院患者登记册的回顾性单中心研究，纳入2015年期间年龄超过16岁、诊断为SE、癫痫发作或癫痫且接受静脉注射抗癫痫药物治疗的患者。如果治疗不符合最新的欧洲、芬兰或美国指南，则认为治疗效果欠佳。
总共记录了109例发作。最大的一组是惊厥性SE，共56例发作，其次是发作后状态23例，非惊厥性癫痫持续状态（NCSE）22例，局灶性意识性SE（FASE）8例。总体而言，77%的发作使用了BZD，43%的发作治疗符合指南。在NCSE组中，BZD的使用频率低于惊厥性SE组，且符合指南的频率也低于惊厥性SE组（27.3%对89.3%，p<0.001；4.5%对55.4%，p<0.001）。对于FASE发作，与指南相符的情况较少。静脉给药后，BZD的平均剂量低于咪达唑仑颊内给药后（2.1mg对8.7mg）或地西泮直肠给药后（4.5mg对10.0mg）。劳拉西泮仅通过静脉途径给药，平均剂量为2.6mg。临床特征不影响BZD的给药剂量。
对于所有SE亚型，BZD的剂量不足且使用不充分。特别是，其在NCSE中的使用频率低且效果欠佳。与指南的差异尤其受到静脉剂量低的影响。
