Underdosing and response to pharmacotherapy in patients with status epilepticus: a retrospective study from Saudi Arabia.

Background: Despite the essential of understanding patterns of status epilepticus (SE) and investigating appropriate therapy for these patients, such data are limited in the Saudi population.

Methods: A retrospective study including adult patients who were admitted to emergency departments (EDs) in two hospitals due to SE was conducted between May 2015 and July 2021. We aimed to describe the characteristics for patients who were admitted to ED with SE, describe the pattern of pharmacotherapy used in these patients, assess patients' response to these pharmacotherapy agents in different stages and investigate reasons for treatment failure.

Results: A total of 420 SE episodes that received at least one dose of benzodiazepines (BDZs) or anti-seizure medications (ASMs) in ED were included. The mean age for them was 38.7 ±19.1 years and 89.0% had a history of epilepsy . BDZs or ASMs were used on first trial in 60.0% and 40.0% of episodes; and 20.6% and 84.5% (p < 0.0001) of these cases responded, respectively. The overall response to BDZs in all trials was 24.8% while it was 79.1% for the ASMs. The issue of under-dosing was more prevalent in BDZs' compared to ASMs trials (63.4% vs. 19.6%) and was significantly associated with lack of response to therapy (86.6% vs. 0.0%; p < 0.0001).

Conclusions: There is an immanent need for educational, drug regulation awareness programs, and protocols enforcement policies that aims to optimize patient care by improving physicians' adherence to clinical guidelines' recommendations to improve the status of managing patients with SE in Saudi Arabia.