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

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Version: Author's accepted manuscript
Serval ID
serval:BIB_8134D1B0DF37
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Practice variability and efficacy of clonazepam, lorazepam, and midazolam in status epilepticus: A multicenter comparison.
Journal
Epilepsia
Author(s)
Alvarez V., Lee J.W., Drislane F.W., Westover M.B., Novy J., Dworetzky B.A., Rossetti A.O.
ISSN
1528-1167 (Electronic)
ISSN-L
0013-9580
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
56
Number
8
Pages
1275-1285
Language
english
Notes
Publication types: Journal Article Publication Status: ppublish
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.
Pubmed
Web of science
Open Access
Yes
Create date
10/08/2015 13:52
Last modification date
20/08/2019 14:41
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