Does Total Benzodiazepine Dose Affect Pediatric ICU Duration for Status Epilepticus?

Low total benzodiazepine dosing is linked to longer intensive care unit stays and seizure duration in children.

The following article is part of conference coverage from the American Epilepsy Society’s Annual Meeting in New Orleans, LA. The Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AES 2018.

NEW ORLEANS — Low total benzodiazepine (BZD) dosing is linked to longer intensive care unit (ICU) stays and seizure duration in children, especially male children and older children with refractory status epilepticus (RSE), according to a research presented at the 72nd Annual Meeting of the American Epilepsy Society, held November 30-December 4, 2018.

Researchers conducted a multi-center, prospective, observational study in a cohort of children aged 1 month to 21 years (N=257; median age of 4.3 years; 54.9% male) with convulsive RSE to identify outcome factors associated with variations in BZD dosing. RSE was defined as failure to terminate SE after treatment with at least 2 antiepileptic drugs or continuous infusion.

The most commonly used BZD was lorazepam (57.9% of participants), followed by diazepam (26.1%), midazolam (13.6%), clonazepam (1.9%), and clobazam (0.4%). A low first single BZD dose was given to 60% of the participants. The researchers defined a low total BZD dose as less than 100% of the minimum recommended dose.

Logistic regression modeling and multivariate Cox regression analysis showed that (1) males (odds ratio [OR] 2.2; 95% CI, 1.28-3.79; =.004) and older children (OR 1.1; 95% CI, 1.04-1.16; <.001) were at independent risk of receiving a low BZD dose upon pre-hospital and post-hospital admission, and (2) low BZD dose is associated with an increased likelihood of prolonged seizure duration (hazard ratio [HR] 0.7; 95% CI, 0.55-0.92) and prolonged ICU stay (HR 0.8; 95% CI, 0.59-0.99).

Researchers conclude that first single BZD dosages were often lower than the recommended minimum in both pre- and post-hospital settings, thus emphasizing the importance of their findings as they apply to clinical settings.

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Vasquez A, Gaínza-Lein M, Fernández IS, et al. Benzodiazepine dosing in pediatric refractory convulsive status epilepticus (the PSERG cohort). Presented at: 72nd Annual Meeting of the American Epilepsy Society; November 30-December 4, 2018; New Orleans, LA. Poster 1.231.