Trial reportEpilepsia2021
Patterns of benzodiazepine underdosing in the Established Status Epilepticus Treatment Trial.
Trial report in Epilepsia, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01960075 (A Multicenter, Randomized, Blinded, Comparative Effectiveness Study of Fosphenytoin, Valproic Acid, or Levetiracetam in the Emergency Department Treatment of Patients With Benzodiazepine-refractory Status Epilepticus.), which is not on this map. Cited by 36 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Multicenter, Randomized, Blinded, Comparative Effectiveness Study of Fosphenytoin, Valproic Acid, or Levetiracetam in the Emergency Department Treatment of Patients With Benzodiazepine-refractory Status Epilepticus.
Who cites it
36 citing papers in PubMed, 1 synthesis or guideline pooled it, 89 citations in OpenAlex.
- Efficacy and Tolerability of Intranasal Midazolam Administration for Antiseizure Treatment in Adults: A Systematic Review.Neurocritical care · 2024Pooled it
- Chronological Sequence of Convulsive Status Epilepticus Treatment Steps in a Real-Life Scenario for Patients Enrolled in a Large Multicenter Trial.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Trial
- Evaluation of the appropriateness of pediatric seizure Management in Primary Care Clinics.Epilepsy & behavior reports · 2026Article
- Assessment of therapeutic management practices in generalized and focal motor status epilepticus: An international survey in French, Belgian, and Swiss intensive care units.Journal of intensive medicine · 2026Article
- Respiratory dysfunction and fatal apnea during pilocarpine-induced status epilepticus.Epilepsia · 2026Article
- Management of Status Epilepticus in Children before and after Implementation of a Treatment Algorithm.The Canadian journal of hospital pharmacy · 2026Article
- Between the retirement of phenytoin and the crowning of levetiracetam: balancing innovation, safety, accessibility and well-established practices.Arquivos de neuro-psiquiatria · 2026Article
- Treatment considerations for the management of neonatal onset seizures.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2025Article
- Underdosing and response to pharmacotherapy in patients with status epilepticus: a retrospective study from Saudi Arabia.Annals of medicine · 2025Article
- A Quality Improvement Initiative to Reduce Underdosing of Rectal Diazepam as Home Seizure Rescue Medication After Hospitalization.Neurology. Clinical practice · 2025Article
- Status epilepticus: Updates on mechanisms and treatments.Epilepsia open · 2025Review
- Guidelines adherence in status epilepticus first steps treatment: factors associated with non-compliance and effect on outcome.Journal of neurology · 2025Article
- Status epilepticus in older adults: A critical review.Epilepsia · 2025Review
- Assessment of Seizure Action Plans in Pediatric Convulsive Status Epilepticus: Focus on Benzodiazepine-Responsive and Resistant Cases.Neurology. Clinical practice · 2025Article
- An Italian Survey on the Management of Pediatric Convulsive Status Epilepticus: More Than Just a Pharmacological Choice.Brain and behavior · 2025Article
- Prognostic factors and impact of management strategies for status epilepticus: The STEPPER study in the Emilia-Romagna region, Italy.Epilepsia · 2025Observational
- Early Polytherapy for Probably Benzodiazepine Refractory Naïve Status Epilepticus (Stage 1 Plus).Neurology international · 2025Review
- Treating status epilepticus in clinical practice-a multi-national survey in Germany, Austria, and Switzerland.Frontiers in neurology · 2025Article
- Strategies to innovate emergency care of status epilepticus.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025Review
- Treatment of convulsive status epilepticus in Brazil: a review.Arquivos de neuro-psiquiatria · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors at 12 institutions in 2 countries.
Funding
Abstract
objectiveThis study was undertaken to describe patterns of benzodiazepine use as first-line treatment of status epilepticus (SE) and test the association of benzodiazepine doses with response to second-line agents in patients enrolled in the Established Status Epilepticus Treatment Trial (ESETT).
methodsPatients refractory to an adequate dose of benzodiazepines for the treatment of SE were enrolled in ESETT. Choice of benzodiazepine, doses given prior to administration of second-line agent, route of administration, setting, and patient weight were characterized. These were compared with guideline-recommended dosing. Logistic regression was used to determine the association of the first dose of benzodiazepine and the cumulative benzodiazepine dose with the response to second-line agent.
resultsFour hundred sixty patients were administered 1170 doses of benzodiazepines (669 lorazepam, 398 midazolam, 103 diazepam). Lorazepam was most frequently administered intravenously in the emergency department, midazolam intramuscularly or intravenously by the emergency medical services personnel, and diazepam rectally prior to ambulance arrival. The first dose of the first benzodiazepine (N = 460) was lower than guideline recommendations in 76% of midazolam administrations and 81% of lorazepam administrations. Among all administrations, >85% of midazolam and >76% of lorazepam administrations were lower than recommended. Higher first or cumulative benzodiazepine doses were not associated with better outcomes or clinical seizure cessation in response to second-line medications in these benzodiazepine-refractory seizures. SIGNIFICANCE: Benzodiazepines as first-line treatment of SE, particularly midazolam and lorazepam, are frequently underdosed throughout the United States. This broad and generalizable cohort confirms prior single site reports that underdosing is both pervasive and difficult to remediate. (ESETT ClinicalTrials.gov identifier: NCT01960075.).
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.