From Guideline to Lifeline: Turning Status Epilepticus Management Evidence Into Improved Outcomes

Status Epilepticus Protocol Variation Across Accredited National Association of Epilepsy Centers Members. Lamberta LK, Asmar M, Fredwall MM, Ahrens SM, Bai S, Eisner M, Lado FA, Schuele SU, Clarke DF, Abdelmoity AT, Davis KA, Hopp JL, Koubeissi MZ, Bensalem Owen MK, Herman ST, Ostendorf AP; NAEC Center Director Study Group. Neurology. 2025; Jun 10;104(11):e213689. doi: 10.1212/WNL.0000000000213689 . Epub 2025 May 16. PMID: 40378375; PMCID: PMC12089659. Objectives: Status epilepticus (SE) is a neurologic emergency that requires urgent recognition and medical management. SE management remains heterogeneous across centers. Methods: We analyzed SE treatment protocols from level 3 and level 4 epilepsy centers. Discrete data including stabilization measures, timing of treatment phases, medications, doses, and routes of administration were collected from each protocol and described using frequency for categorical variables and median for continuous variables. The distribution of treatment times and dosing were compared with the AES guideline. Results: A total of 256 SE treatment protocols were included. Only 66% of SE protocols detailed treatment times. Doses below recommendations occurred in 4% of protocols for initial benzodiazepine (BZD) and 14% for first non-BZD medications. Infusion therapy was outlined in 61% of protocols. Discussion: Despite the importance of timeliness in SE management, one third of institutional protocols did not specify treatment times. This analysis of US hospital inpatient SE protocols provides expert opinion regarding infusion therapy management and highlights gaps and targets for improvement in SE treatment.