Editors' Note: Prehospital Midazolam Use and Outcomes Among Patients With Out-of-Hospital Status Epilepticus

Abstract

Dr. Guterman et al. reported a cross-sectional analysis of 2,494 adult patients with status epilepticus treated by an emergency medical services agency from 2013 to 2018, of whom 1,537 patients received midazolam. They found that higher midazolam doses were associated with reduced use of rescue therapy without an increased need for ventilator support. In response, Dr. Kellinghaus et al. note that the findings are in keeping with their data from a large European prospective registry, which showed that a lower cumulative dose of anticonvulsant agents within the first 30–60 minutes was associated with the risk of refractoriness of the status episode. They caution against undertreatment of status epilepticus and call for further studies to help bridge the knowledge-to-practice gap in status care. Responding to these comments, the authors agree and note that they are expanding their work to examine status epilepticus treatment across several prehospital systems in the United States. This exchange highlights the challenge of ensuring early intensive management of patients with status epilepticus—the evidence is clear, but we must translate it into routine practice. Dr. Guterman et al. reported a cross-sectional analysis of 2,494 adult patients with status epilepticus treated by an emergency medical services agency from 2013 to 2018, of whom 1,537 patients received midazolam. They found that higher midazolam doses were associated with reduced use of rescue therapy without an increased need for ventilator support. In response, Dr. Kellinghaus et al. note that the findings are in keeping with their data from a large European prospective registry, which showed that a lower cumulative dose of anticonvulsant agents within the first 30–60 minutes was associated with the risk of refractoriness of the status episode. They caution against undertreatment of status epilepticus and call for further studies to help bridge the knowledge-to-practice gap in status care. Responding to these comments, the authors agree and note that they are expanding their work to examine status epilepticus treatment across several prehospital systems in the United States. This exchange highlights the challenge of ensuring early intensive management of patients with status epilepticus—the evidence is clear, but we must translate it into routine practice.