title: A retrospective observational study of current treatment for generalized convulsive status epilepticus.
abstract: OBJECTIVE
  This study aimed at determining the current state of practice of treatment for acute generalized convulsive status epilepticus (GCSE) and responsiveness to therapy.
  
  
  METHODS
  This observational study was performed by retrospectively identifying patients with GCSE presenting to an emergency room setting. The primary outcome was seizure cessation following medication administration. Secondary outcomes were rates of intubation and mortality.
  
  
  RESULTS
  One hundred seventy-seven episodes of GCSE were identified. All patients, except 1, received a benzodiazepine for first-line treatment. Only 11% of these patients, all children, were treated with at least 0.1mg/kg of lorazepam or an equivalent dose of an alternative benzodiazepine. A first-line treatment was effective in 56% of the patients, a second-line treatment in an additional 28%, and a third-line treatment in 12%. Phenytoin was the most prescribed second-line treatment (41%) but statistically significantly least effective (22% versus 86% seizure cessation, p<0.0001) compared with all other second-line agents together. Propofol was the most prescribed third-line treatment.
  
  
  CONCLUSIONS
  Results emphasize that, in clinical practice, approximately half of GCSE patients respond to first-line therapy and, among nonresponders, approximately two-thirds respond to second-line and approximately three-quarters respond to third-line therapies. The variations in treatment selection reflect that there are no randomized controlled trials to guide treatment beyond use of benzodiazepines for first-line treatment. The observation that phenytoin is statistically substantially worse than other second-line treatments raises the possibility that the most commonly selected second-line treatment is the least effective and provides equipoise for a large randomized controlled trial of second-line therapies.
authors.affiliation: Department of Neurology, University of Virginia, Charlottesville, VA, USA. Electronic address: jl2gw@virginia.edu.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Langer
authors.affiliation: Department of Neurology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Nathan B
authors.initials: NB
authors.lastname: Fountain
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data; D004632:Emergency Medical Services; D004829:Epilepsy, Generalized / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000627:therapeutic use; D015742:Propofol / Q000627:therapeutic use; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D001569:Benzodiazepines; D010672:Phenytoin; D015742:Propofol
keywords: Generalized convulsive status epilepticus; Status epilepticus; Treatment