{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:14:09Z","timestamp":1789578849149,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>The treatment of status epilepticus (SE) follows a stepwise approach, with benzodiazepines (BDZ) being the first-line therapy. This study analyzed real-word data on use of BDZ and non-BDZ antiseizure medications (ASMs) in SE treatment over 9-years to evaluate whether non-BDZ given as a first-line treatment affect 30-day mortality and other outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included SE cases in patients aged \u226514\u202fyears who were prospectively registered at Baggiovara Civil Hospital (Modena, Italy) between September 1, 2013, and October 31, 2021. First-line treatment choices were dichotomized as: (i) i.v. BDZ; (ii) other ASMs. A multivariate model with logistic regression and an adjusted stepwise method for variables was used. Then, a propensity-score matched analysis was performed with clinical variables unevenly distributed between the two groups to evaluate the independent association between first-line therapy and 30-day mortality and secondary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six hundred and thirty patients were included: 73.5% (463\/630) received a BDZ as first-line therapy and 26.5% (167\/630) were treated with non-BDZ. In the primary analyses of the whole cohort, 30-day mortality was 25.9 and 35.3% in patients receiving BDZ and non-BDZ, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.027). However, multivariate analysis adjusted for potential confounders showed that non-BDZ treatment was not independently associated with increased 30-day mortality. Patients who received BDZ as a first-line treatment had less orotracheal intubation and anesthetics within 24\u202fh of SE onset; less frequent progression to refractory and super-refractory status epilepticus; less admission to and shorter stay in intensive care units; shorter time to SE cessation. In the propensity cohort (140 patients, mainly non-convulsive SE; NCSE), 30-day mortality was 30.7% (43\/140), with no difference between BDZ-treated patients (30%; 21\/70) and those who received non-BDZ (31.4%; 22\/70) (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f1.000). No difference in secondary outcomes was found, except for a shorter time to SE cessation among BDZ-treated patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The use of non-BDZ first-line treatment was found to be frequent, approaching 25%. Our propensity-score matching analysis shows that in some patients, mainly with NCSE, the overall prognosis of SE was not affected by first-line use of non-BDZ drugs. In these cases, SE prognosis might only be partially dependent on the first medications administered and could be more influenced by other biological variables.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1681483","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T15:16:12Z","timestamp":1762960572000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Benzodiazepines versus non-benzodiazepine antiseizure medications as first-line agents for status epilepticus: analysis of real word data from a 9-years prospective cohort"],"prefix":"10.3389","volume":"16","author":[{"given":"Francesco","family":"Brigo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianni","family":"Turcato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giada","family":"Giovannini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Lattanzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arian","family":"Zaboli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccol\u00f2","family":"Orlandi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margherita","family":"Burani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Taruffi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Affronte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Meletti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.eplepsyres.2017.07.006","article-title":"Status epilepticus-related etiology, incidence and mortality: a meta-analysis","volume":"136","author":"Lv","year":"2017","journal-title":"Epilepsy Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.eplepsyres.2016.08.016","article-title":"Status epilepticus in the elderly\u2014a retrospective study on 120 patients","volume":"127","author":"Rohracher","year":"2016","journal-title":"Epilepsy Res"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1111\/epi.14607","article-title":"Epidemiology of status epilepticus in adults: a population-based study on incidence, causes, and outcomes","volume":"60","author":"Leitinger","year":"2019","journal-title":"Epilepsia"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.1111\/epi.13121","article-title":"A definition and classification of status epilepticus\u2014report of the ILAE task force on classification of status epilepticus","volume":"56","author":"Trinka","year":"2015","journal-title":"Epilepsia"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2802","DOI":"10.1093\/brain\/awr215","article-title":"The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol","volume":"134","author":"Shorvon","year":"2011","journal-title":"Brain"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s12028-012-9695-z","article-title":"Guidelines for the evaluation and management of status epilepticus","volume":"17","author":"Brophy","year":"2012","journal-title":"Neurocrit Care"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"48","DOI":"10.5698\/1535-7597-16.1.48","article-title":"Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society","volume":"16","author":"Glauser","year":"2016","journal-title":"Epilepsy Curr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"106675","DOI":"10.1016\/j.yebeh.2019.106675","article-title":"Management of status epilepticus in adults. 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