{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T21:45:51Z","timestamp":1747172751456,"version":"3.40.5"},"reference-count":29,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2019,8,15]],"date-time":"2019-08-15T00:00:00Z","timestamp":1565827200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. J. Neurol. Sci."],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>ABSTRACT:<\/jats:title><jats:sec id=\"S0317167119002786_as1\"><jats:title>Background:<\/jats:title><jats:p>Status epilepticus (SE) is a neurological emergency associated with significant morbidity and mortality. The objective of this study was to review the critical care management of patients with SE focusing on antiepileptic drugs (AEDs) as well as to determine the optimal dosing strategies of phenytoin (PHT) and predictors of its effectiveness.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167119002786_as2\"><jats:title>Methods:<\/jats:title><jats:p>A retrospective chart review of adult patients with SE admitted to the University of Alberta Hospital, Canada, was conducted.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167119002786_as3\"><jats:title>Results:<\/jats:title><jats:p>Fifty-six admissions were included. Benzodiazepines (BDZs) were initially given in 89% of our patients. Following BDZs, PHT and levetiracetam were the most commonly initiated AEDs as first- and second-line agents and were deemed effective in 30\/44 and 5\/11 patients, respectively. Patients who received a PHT loading dose (LD) of 1000 mg were less likely to reach target levels compared with a weight-based LD \u226515 mg\/kg (29% vs. 60%). Likewise, patients who received a maintenance dose (MD) of 300 mg\/day were less likely to reach target compared with 400 mg\/day or &gt;5 mg\/kg per day; however, this did not reach statistical significance. Three variables were found to be associated with PHT effectiveness: tonic-clonic SE (OR 5.01, 95% CI 1.02\u201324.7, p = 0.048), history of seizures and BMI &lt;30 kg\/m<jats:sup>2<\/jats:sup>(OR 0.16, 95% CI 0.03\u20131.07, p = 0.059).<\/jats:p><\/jats:sec><jats:sec id=\"S0317167119002786_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>Further studies of the predictors of PHT effectiveness, specifically obesity, are necessary to help individualize care. Finally, we suggest that PHT should be loaded according to the guidelines as 20 mg\/kg followed by an MD of at least 400 mg\/day or &gt;5 mg\/kg per day.<\/jats:p><\/jats:sec>","DOI":"10.1017\/cjn.2019.278","type":"journal-article","created":{"date-parts":[[2019,8,15]],"date-time":"2019-08-15T10:53:46Z","timestamp":1565866426000},"page":"702-710","source":"Crossref","is-referenced-by-count":1,"title":["Critical Care Management of Status Epilepticus at a Tertiary Care University Hospital"],"prefix":"10.1017","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5517-2622","authenticated-orcid":false,"given":"Sherif Hanafy","family":"Mahmoud","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Marette","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Therecia","family":"Lindqvist","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. Nizam","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2019,8,15]]},"reference":[{"key":"S0317167119002786_ref8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.331.7518.673"},{"key":"S0317167119002786_ref29","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2008.01561.x"},{"key":"S0317167119002786_ref28","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.32.5.570"},{"key":"S0317167119002786_ref24","unstructured":"24. OMEGA LABORATORIES LTD. Phenytoin Monograph [product monograph]. Health Canada; 2017. Available at: https:\/\/pdf.hres.ca\/dpd_pm\/00045167.PDFx; accessed February 11, 2019."},{"key":"S0317167119002786_ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-014-0452-x"},{"key":"S0317167119002786_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2013.12.007"},{"key":"S0317167119002786_ref25","unstructured":"25. Canadian Pharmacists Association. Phenytoin [product monograph]. Ottawa (ON); 2017. Available at: http:\/\/www.e-cps.ca; accessed February 11, 2019."},{"key":"S0317167119002786_ref23","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp140039"},{"key":"S0317167119002786_ref11","doi-asserted-by":"publisher","DOI":"10.5698\/1535-7597-16.1.48"},{"key":"S0317167119002786_ref17","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2005.080887"},{"key":"S0317167119002786_ref4","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1684\/epd.2007.0069","article-title":"Treatment adherence and outcomes in the management of convulsive status epilepticus in the emergency room","volume":"9","author":"Muayqil","year":"2007","journal-title":"Epileptic Disord"},{"key":"S0317167119002786_ref26","unstructured":"26. Lexi-Drugs Online. Phenytoin. Wolters Kluwer Health; 2019. 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