Practice variability and efficacy of clonazepam, lorazepam, and midazolam in status epilepticus: A multicenter comparison.

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.

journal_name

Epilepsia

journal_title

Epilepsia

authors

Alvarez V,Lee JW,Drislane FW,Westover MB,Novy J,Dworetzky BA,Rossetti AO

doi

10.1111/epi.13056

subject

Has Abstract

pub_date

2015-08-01 00:00:00

pages

1275-85

issue

8

eissn

0013-9580

issn

1528-1167

journal_volume

56

pub_type

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    journal_title:Epilepsia

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

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    更新日期:1994-05-01 00:00:00

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    pub_type: 临床试验,杂志文章,随机对照试验

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    authors: Suzuki F,Heinrich C,Boehrer A,Mitsuya K,Kurokawa K,Matsuda M,Depaulis A

    更新日期:2005-02-01 00:00:00