Treatment of nonfebrile status epilepticus in Rochester, Minn, from 1965 through 1984

Objective: To investigate the adequacy and efficacy of antiepileptic drug (AED) treatment of nonfebrile status epilepticus (SE). Patients and Methods: We performed a population-based retrospective cohort study to evaluate the medical management of SE. Participants included 184 residents of Rochester, Minn, who experienced a first episode of nonfebrile SE between 1965 and 1984. Results: Of the 184 patients, 133 (72.2%) received appropriate, prompt medical treatment for SE, ie, intravenous diazepam, phenytoin, or phenobarbital. In 100 patients (75.8%), the dose of the first AED administered was less than that currently recommended. The first treatment was effective in terminating SE in 41 (31.1%) of 132 patients. The adequacy of treatment was highly predictive of drug efficacy (P=.002). The dose of the second AED treatment was inadequate in 52 (80%) of 65 patients treated. Conclusion: Based on this retrospective study, the treatment of SE is remarkable for both inadequacy and ineffectiveness. The inappropriate use of therapeutic regimens in the management of SE may be an important cause of ineffective medical treatment.