Titre
Practice variability and efficacy of clonazepam, lorazepam, and midazolam in status epilepticus: A multicenter comparison.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Auteur(s)
Alvarez, V.
Auteure/Auteur
Lee, J.W.
Auteure/Auteur
Drislane, F.W.
Auteure/Auteur
Westover, M.B.
Auteure/Auteur
Novy, J.
Auteure/Auteur
Dworetzky, B.A.
Auteure/Auteur
Rossetti, A.O.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1528-1167
Statut éditorial
Publié
Date de publication
2015
Volume
56
Numéro
8
Première page
1275
Dernière page/numéro d’article
1285
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article Publication Status: ppublish
Résumé
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.
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.
PID Serval
serval:BIB_8134D1B0DF37
PMID
Open Access
Oui
Date de création
2015-08-10T12:52:57.241Z
Date de création dans IRIS
2025-05-21T03:12:58Z
Fichier(s)![Vignette d'image]()
En cours de chargement...
Nom
BIB_8134D1B0DF37.P001.pdf
Version du manuscrit
postprint
Taille
1008.56 KB
Format
Adobe PDF
PID Serval
serval:BIB_8134D1B0DF37.P001
URN
urn:nbn:ch:serval-BIB_8134D1B0DF376
Somme de contrôle
(MD5):7ede4cdd1b7e276802b6785f10c1c941