Treating status epilepticus in clinical practice : a multi-national survey in Germany, Austria, and Switzerland
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Frontiers
Abstract
Background: Status epilepticus (SE) is a life-threatening neurological
emergency, and exhibits significant variability in clinical management despite
established guidelines. This study evaluates current practices across German
speaking countries.
Methods: A web-based survey (December 2023–May 2024) assessed SE
treatment strategies among 83 neurologists and neurointensivists from
Germany, Austria, and Switzerland. Cases were presented to analyze diagnostic
and therapeutic preferences.
Results: The preferred benzodiazepine for first line treatment was lorazepam,
chosen by 71.6% of the respondents. In the case of established SE, 35.4% chose
levetiracetam as the preferred ASM. Propofol in combination with sufentanil/
fentanyl was the preferred anesthetic of choice in 65.4% of respondents. For
super-refractory status epilepticus (SRSE), 41.5% prefer to add further ASM,
with valproic acid (67.1%), and lacosamide (64.5%) being the most frequently
selected. Only 31.8% reported that their emergency services have a standard
operating procedure (SOP) for SE treatment, and the choice of the preferred
benzodiazepine varied in the preclinical setting, with midazolam being the
most commonly used. 1) First-line therapy: Lorazepam (71.6% in-hospital),
midazolam (50% prehospital), 2) Second-line therapy: Levetiracetam (35.4%)
and lacosamide (13.4%) were the most common choices, 3) Refractory SE:
Propofol with opioids (65.4%) were preferred for anesthesia, 4) Prehospital care:
31.8% of emergency services lacked standardized protocols; midazolam dosing
varied widely (2–10 mg).
Diagnostics: Laboratory testing was universal (96.9%), but MR-imaging (10%)
and clinical use of prognostic scores (6.2%) were underutilized.
Conclusion: This survey highlights the variability in clinical practice for managing
status epilepticus in German-speaking countries. Persistent heterogeneity in SE
management underscores the need for standardized protocols, particularly in
prehospital care and refractory SE therapy.
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