Evidence map›Paper›PMID 35094154›Full record

SynthesisJournal of neurology2022

Management of the first stage of convulsive status epilepticus in adults: a systematic review of current randomised evidence.

Moira Cruickshank, Mari Imamura, Carl Counsell, Lorna Aucott, Paul Manson, Corinne Booth, Graham Scotland, Miriam Brazzelli

Open access · hybridAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of neurology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
1.8field-weighted citation impact, top 16% of its field
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 1 institution in 1 country.

Moira CruickshankHealth Services Research Unit, University of Aberdeen, Aberdeen, UK.ORCID http://orcid.org/0000-0002-5182-884X
Mari ImamuraHealth Services Research Unit, University of Aberdeen, Aberdeen, UK.
Carl CounsellInstitute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Lorna AucottHealth Services Research Unit, University of Aberdeen, Aberdeen, UK.
Paul MansonHealth Services Research Unit, University of Aberdeen, Aberdeen, UK.
Corinne BoothIndependent Consultant, Health Economist, Glasgow, UK.
Graham ScotlandHealth Services Research Unit and Health Economics Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
Miriam BrazzelliHealth Services Research Unit, University of Aberdeen, Aberdeen, UK. m.brazzelli@abdn.ac.uk.
University of Aberdeen · GB

Funding

Chief Scientist Office HSRU1National Institute for Health Research 132153
6 · The paper itself

Abstract

backgroundConvulsive status epilepticus is the most severe form of epilepsy and requires urgent treatment. We synthesised the current evidence on first-line treatments for controlling seizures in adults with convulsive status epilepticus before, or at, arrival at hospital.

methodsWe conducted a systematic review of randomised controlled trials (RCTs) assessing antiepileptic drugs offered to adults as first-line treatments. Major electronic databases were searched.

resultsFour RCTs (1234 adults) were included. None were conducted in the UK and none assessed the use of buccal or intranasal midazolam. Both intravenous lorazepam and intravenous diazepam administered by paramedics were more effective than placebo and, notably, intramuscular midazolam was non-inferior to intravenous lorazepam. Overall, median time to seizure cessation from drug administration varied from 2 to 15 min. Rates of respiratory depression among participants receiving active treatments ranged from 6.4 to 10.6%. Mortality ranged from 2 to 7.6% in active treatment groups and 6.2 to 15.5% in control groups.

conclusionsIntravenous and intramuscular benzodiazepines are safe and effective in this clinical context. Further research is needed to establish the most clinically and cost-effective first-line treatment and preferable mode of administration. Head-to-head trials comparing buccal versus intranasal midazolam versus rectal diazepam would provide useful information to inform the management of the first stage of convulsive status epilepticus in adults, especially when intravenous or intramuscular access is not feasible. Approaches to improve adherence to clinical guidelines on the use of currently available benzodiazepines for the first-line treatment of convulsive status epilepticus should also be considered.

Indexed as

LorazepamStatus EpilepticusAdultAnticonvulsantsDiazepamHumansMidazolamSeizuresAnticonvulsantsDiazepamLorazepamMidazolamAntiepileptic drugsBenzodiazepinesConvulsive status epilepticusFirst-line treatmentReview

Identifiers

PMID35094154
PMCPMC9217864
OpenAlexW4210307844

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.