Evaluation of Antiepileptic Therapy and Outcomes in Status Epilepticus Patients Presenting to the Emergency Department Michelle Tubolino, Megan Heath DCH Regional Medical Center-Tuscaloosa, Alabama Background/Purpose: Assess guideline-based selection and dosing of the initial antiepileptic drug (AED) administered in the emergency department (ED) in patients presenting with status epilepticus (SE) at a large community hospital.
Methodology: Retrospective chart review where patients were screened from July 15, 2023 to July 14, 2025. Eligible patients were those who received greater than or equal to one AED in the emergency department and had a status epilepticus diagnosis documented by a provider during that encounter. AED selection and dose were assessed for appropriateness in accordance with the American Epilepsy Society (AES) 2016 guidelines.
Results: 63 patients were included in this study. Thirty-six patients had a documented history of seizure disorder and thirty were on antiepileptic medications at home. Thirty-nine patients received a benzodiazepine prior to ED arrival, with midazolam being the most frequently used. Average time to first AED administration from seizure onset was nine minutes. 18 (28.6%) patients received an appropriate agent and weight-based dose in the ED. Out of the 13 patients who receive guideline adherent weight-based dosing of a second-line agent, 12 had pharmacists involved in their care.
Conclusions: Majority of patients received lower than recommended weight-based doses of benzodiazepines and second-line AEDs in the ED. Most patients who received the appropriate initial agent and dose for status epilepticus had pharmacist involvement in their care, suggesting the impact of pharmacist intervention on treatment optimization.
Presentation Objective: the application of the American Epilepsy Society (AES) treatment guidelines for pharmacologic management of status epilepticus in the emergency department. Self-Assessment: What is one of the most common reasons for benzodiazepine underdosing in status epilepticus?
