{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:40:28Z","timestamp":1786977628446,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epileptic Disorders"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Refractory status epilepticus (RSE) is a medical emergency defined as \u201cstatus epilepticus persisting despite administration of at least 2 appropriately selected and dosed parenteral medications including a benzodiazepine.\u201d Control of RSE is critical to avoid irreversible neuronal damage, with midazolam and propofol as the most commonly used agents. This study evaluates the effectiveness of midazolam versus propofol in preventing mortality and complications of RSE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients from the TriNetX Research Network who received either midazolam or propofol monotherapy on the day of RSE onset were included. Outcomes were assessed at 30\u2009days and maximal follow\u2010up (\u226420\u2009years) using Cox proportional hazard models. Propensity score matching (1:1) controlled for demographics and 93 comorbidities from the Charlson Comorbidity Index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 117\u2009736 patients with RSE, 5310 received midazolam and 2136 received propofol. Midazolam was associated with significantly decreased hazards of mortality at 30\u2009days (HR\u2009=\u20090.509 [95% CI: 0.397, 0.653]) but not at maximal follow\u2010up (HR\u2009=\u20090.922 [0.797, 1.067]). Midazolam was also associated with significantly reduced hazards of lactic acidosis (HR\u2009=\u20090.537 [0.427, 0.674]), rhabdomyolysis (HR\u2009=\u20090.295 [0.150, 0.578]), hypertriglyceridemia (HR\u2009=\u20090.316 [0.135, 0.740]), tracheostomy (HR\u2009=\u20090.633 [0.438, 0.916]), PEG placement (HR\u2009=\u20090.519 [0.371, 0.725]), and mechanical ventilation (HR\u2009=\u20090.313 [0.265, 0.370]). Among patients with a traumatic brain injury in the week prior to RSE, midazolam was associated with a significantly lower hazard of 30\u2010day mortality (HR\u2009=\u20090.381 [0.136, 0.993]), while the hazards were not significantly changed in patients with CNS infections (HR\u2009=\u20091.150 [0.351, 3.768]) or cerebrovascular disease (HR\u2009=\u20090.656 [0.421, 1.025]) in the week prior to RSE onset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Midazolam monotherapy for RSE was associated with decreased mortality and adverse effects compared to propofol monotherapy in the short term, but relatively equivalent in the long term. Prospective comparative trials are needed to ascertain superiority of either intervention in reducing morbidity and mortality in patients with RSE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epd2.70174","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T16:05:51Z","timestamp":1768233951000},"page":"448-456","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["First\u2010line infusion therapies in refractory status epilepticus: A retrospective comparison of outcomes between midazolam and propofol in 7446 patients"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6296-3793","authenticated-orcid":false,"given":"Isaac B.","family":"Thorman","sequence":"first","affiliation":[{"name":"School of Medicine New York Medical College  Valhalla New York USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6236-1190","authenticated-orcid":false,"given":"Ariel","family":"Sacknovitz","sequence":"additional","affiliation":[{"name":"School of Medicine New York Medical College  Valhalla New York USA"},{"name":"Department of Neurosurgery Westchester Medical Center  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1915-8249","authenticated-orcid":false,"given":"Richard","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Medicine New York Medical College  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3381-0635","authenticated-orcid":false,"given":"Patricia E.","family":"McGoldrick","sequence":"additional","affiliation":[{"name":"School of Medicine New York Medical College  Valhalla New York USA"},{"name":"Department of Pediatric Neurology Boston Children's Health Physicians of NY and CT  Hawthorne New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5975-374X","authenticated-orcid":false,"given":"Michael C.","family":"Schubert","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins University  Baltimore Maryland USA"},{"name":"Department of Physical Medicine and Rehabilitation Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1272-6277","authenticated-orcid":false,"given":"Stephan A.","family":"Mayer","sequence":"additional","affiliation":[{"name":"School of Medicine New York Medical College  Valhalla New York USA"},{"name":"Department of Neurosurgery Westchester Medical Center  Valhalla New York USA"},{"name":"Department of Neurology Westchester Medical Center  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outcome of therapies in refractory and super\u2010refractory convulsive status epilepticus and recommendations for therapy","volume":"135","author":"Ferlisi M","year":"2012","journal-title":"Brain"}],"container-title":["Epileptic 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