{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:41:40Z","timestamp":1791319300328,"version":"4.3.1"},"reference-count":45,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"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":["Epilepsia"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Treatment strategies for non\u2010convulsive status epilepticus (NCSE) are largely extrapolated from convulsive SE, despite biological and clinical differences. NCSE arises from heterogeneous etiological substrates that may influence treatment response and prognosis. We examined the association between treatment sequence, anti\u2010seizure medication (ASM) adequacy, etiological context, and clinical outcomes in NCSE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 189 adult non\u2010anoxic NCSE patients from a 6\u2010year ambispective registry. Treatment variables included first\u2010line benzodiazepine (BDZ) use, ASM underdosing, and escalation to continuous intravenous anesthetic drugs (CIVADs). Etiology was classified according to International League Against Epilepsy (ILAE) categories and further stratified as potentially fatal v non\u2010fatal and as primary vs secondary central nervous system (CNS) pathology. Outcomes were failure of NCSE cessation, in\u2010hospital mortality, and functional worsening at discharge. Associations between treatment patterns and outcomes were evaluated using univariate and multivariable logistic regression analyses, with exploratory pre\u2010specified subgroup analyses across etiological categories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ASM underdosing occurred in 73 of 189 episodes (38.6%) and was independently associated with failure of NCSE cessation (odds ratio [OR] 6.56, 95% confidence interval [CI] 1.98\u201321.78) and in\u2010hospital mortality (OR 4.38, 95% CI 2.01\u20139.54). Lack of first\u2010line BDZs (93\/189, 49.2%) and escalation to CIVADs (41\/189, 21.7%) were not independently associated with outcome. In subgroup analyses, the association between ASM underdosing and adverse outcomes was observed more consistently in acute primary CNS pathology and non\u2010fatal etiologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>In NCSE, outcome appears more closely associated with ASM dosing adequacy than strict adherence to a pre\u2010defined treatment sequence, particularly in clinical contexts where epileptic activity is likely to contribute substantially to prognosis. Pending future prospective, ideally randomized, investigations, optimal therapeutic strategies across heterogeneous NCSE subtypes remain to be clearly established.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70297","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T10:23:45Z","timestamp":1779272625000},"page":"4025-4036","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Treatment adequacy outweighs treatment sequence in non\u2010convulsive status epilepticus"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8730-4397","authenticated-orcid":false,"given":"Francesco","family":"Misirocchi","sequence":"first","affiliation":[{"name":"Unit of Neurology, Department of Medicine and Surgery University of Parma  Parma Italy"},{"name":"Unit of Neurology University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8830-9236","authenticated-orcid":false,"given":"Alessandro","family":"Zilioli","sequence":"additional","affiliation":[{"name":"Unit of Neurology, Department of Medicine and Surgery University of Parma  Parma Italy"},{"name":"Unit of Neurology University Hospital of Parma  Parma Italy"},{"name":"Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2956-7612","authenticated-orcid":false,"given":"Lucia","family":"Zinno","sequence":"additional","affiliation":[{"name":"Unit of Neurology University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1314-5706","authenticated-orcid":false,"given":"Irene","family":"Florindo","sequence":"additional","affiliation":[{"name":"Unit of Neurology University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.5698\/1535-7597-16.1.48"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13121"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/CON.0000000000001103"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17982"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnp.2019.07.001"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ane.12732"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.18227"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006393"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02888.x"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-022-00664-3"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17694"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2015.05.005"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2025.1721546"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2015.05.007"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2006.00870.x"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-012-6644-x"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-025-13349-w"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2025.1645435"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24986"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2018.04.005"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17753"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2026.1763224"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2024.04.018"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17830"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.034480"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-008-0989-1"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-014-0080-y"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-012-9695-z"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2005.080887"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000201099"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2025.1681483"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25416"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-021-01502-4"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-023-07263-w"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000214624"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16573"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2013.154"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17319"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.18275"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2022.109027"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17614"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1002\/epi.70169"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-018-1997-x"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnp.2022.08.001"}],"container-title":["Epilepsia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epi.70297","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/epi.70297","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epi.70297","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T10:05:14Z","timestamp":1787997914000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/epi.70297"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":45,"journal-issue":{"issue":"8","publis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