Better meta-analytic methods, but best initial treatment for status epilepticus remains obscure
Citation Manager Formats
Make Comment
See Comments

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
The most effective benzodiazepine and route of delivery to use as initial treatment for people in status epilepticus is not clear, despite many small and a few medium and large clinical trials. There are many potential choices of both drug and route. Everybody has their favorite and a reason for their choice. Americans like lorazepam, for which there is a wealth of data, but they consistently underdose it. The British favor midazolam and continental Europeans often choose clonazepam for its favorable pharmacology, but hunger for randomized clinical data to support their preconceived conclusions. Families of people with epilepsy prefer giving agents across the buccal mucosa rather than rectally. Some paramedics like the certainty of an IM injection and others the needleless-ness of an intranasal atomizer. Administrators want to avoid higher-cost preparations and favor agents with long shelf lives without refrigeration. Clinical investigations are typically designed with only one of these aspects in mind. As with the blind men and the elephant (figure), a coherent view of the big picture remains elusive. How, then, are we to best understand the data surrounding this clinical question?
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.
See page 1859
- © 2015 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
Letters: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Dr. Jeffrey Allen and Dr. Nicholas Purcell
► Watch
Related Articles
Topics Discussed
Alert Me
Recommended articles
-
Article
Efficacy of nonvenous medications for acute convulsive seizuresA network meta-analysisRavindra Arya, Harsh Kothari, Zongjun Zhang et al.Neurology, October 28, 2015 -
Drugs and Devices
Development of benzodiazepines for out-of-hospital management of seizure emergenciesSuresh K. Agarwal, James C. Cloyd et al.Neurology: Clinical Practice, December 12, 2014 -
Article
Prehospital midazolam use and outcomes among patients with out-of-hospital status epilepticusElan L. Guterman, Joseph K. Sanford, John P. Betjemann et al.Neurology, September 17, 2020 -
Article
First-line medication dosing in pediatric refractory status epilepticusAlejandra Vasquez, Marina Gaínza-Lein, Nicholas S. Abend et al.Neurology, September 10, 2020