Mayo Clin Proc, January 2001, Vol 76 Treatment of Nonfebrile Status Epilepticus 39 Mayo Clin Proc. 2001;76:39-41 39 © 2001 Mayo Foundation for Medical Education and Research Original Article Treatment of Nonfebrile Status Epilepticus in Rochester, Minn, From 1965 Through 1984 GREGORY D. CASCINO, MD; DALE HESDORFFER, PHD; GIANCARLO LOGROSCINO, MD; AND W. ALLEN HAUSER, MD From the Department of Neurology, Mayo Clinic, Rochester, Minn (G.D.C.); G. H. Sergievsky Center, College of Physicians and Sur- geons, Columbia University, New York, NY (D.H., W.A.H.); and Divisione di Neurologia, Ospedale Miulli Acquaviva, Bari, Italy (G.L.). Address reprint requests and correspondence to Gregory D. Cascino, MD, Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: gcascino@mayo.edu). • 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 ap- propriate, prompt medical treatment for SE, ie, intrave- nous diazepam, phenytoin, or phenobarbital. In 100 pa- tients (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 pa- tients. The adequacy of treatment was highly predictive of drug efficacy (P=.002). The dose of the second AED treat- ment 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 regi- mens in the management of SE may be an important cause of ineffective medical treatment. Mayo Clin Proc. 2001;76:39-41 AED = antiepileptic drug; SE = status epilepticus S tatus epilepticus (SE) is a medical emergency charac- terized by repeated or continuous seizure activity. 1-5 An estimated 102,000 to 150,000 episodes of SE occur in the United States annually. 1,2 Generalized convulsive SE asso- ciated with tonic-clonic seizure activity is the most fre- quently occurring presentation. 1-13 The overall 30-day mortality rate among patients with SE is approximately 20%. 8,9,11 Neurologic outcome is worse in elderly patients, patients with an acute symptomatic cause, or both. 8-13 Gener- alized convulsive SE requires prompt and effective treat- ment to avoid severe neurologic morbidity and death. 1-3,8,11-14 No population-based data exist on the adequacy and efficacy of antiepileptic drug (AED) treatment after an initial episode of SE. We performed this population-based retrospective cohort analysis to evaluate the treatment of SE. PATIENTS AND M ETHODS Residents of Rochester, Minn, were identified who experi- enced an initial episode of SE between January 1, 1965, and December 31, 1984, by using the Rochester Epidemi- ology Project linkage system. 3,5,8,9,15,16 The patients with SE were from the 1935 to 1985 series of patients with convul- sive disorders. However, we excluded the patients in the initial 30 years because of improvement in case ascertain- ment in the later decades and because of the introduction of diazepam in the 1960s for the treatment of SE. Status epilepticus was defined as continuous or repetitive seizure activity lasting longer than 30 minutes without neurologic recovery. 1 We excluded patients with subclinical electro- graphic seizures in whom ictal events were terminated in less than 30 minutes by AED therapy. Two investigators (G.D.C. and W.A.H.) identified the patients with SE, con- firmed the type of seizure and clinical course, and deter- mined the presence of precipitating factors and etiology. The adequacy and efficacy of intravenous medical therapy for SE were determined by a review of medical records and patient correspondence. For purposes of this study, appropriate treatment of SE was intravenous phe- nobarbital, phenytoin, or diazepam. 10 The minimum dos- ages of AED therapy considered adequate were as follows: diazepam—adults, 0.15 mg/kg; children, 0.1 mg/kg; phenytoin—adults, 15 mg/kg; children, 20 mg/kg; and phe- nobarbital—adults and children, 20 mg/kg. 10 All patients had their body weight recorded at the time of the first episode of SE. RESULTS We verified that 184 patients experienced their first epi- sode of nonfebrile SE between 1965 and 1984. 9 The mean age of these patients was 47.2 years (range, 1-93 years). For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.