Intravenous Clonazepam in Status Epilepticus

Status epilepticus (SE) is a major neurologic emergency that is associated with case-fatality rates ranging from 3% to 39% across studies (1), leading to 55,000 deaths per year in the United States (2).Prompt treatment of SE correlates with better outcome (3), and numerous studies have led to the recommendation that benzodiazepines (BZD) should be administered as a first-line treatment.However, there is little agreement as to which benzodiazepine and route of administration are best.Different studies have compared different BZDs and routes of administration, with notable heterogeneity in the utilized methodology and major paucity of data about clonazepam (CLZ).The RAMPART study, for example, compared midazolam (MDZ), given through an intramuscular autoinjector, with intravenous lorazepam (LZP) given by the paramedics prior to arrival to the emergency department, concluding superiority of MDZ (4).Other studies analyze similarly collected data to either evaluate a particular benzodiazepine, a particular route of administration, or both.A recent such study performed a network meta-analysis of nonvenous drugs used in randomized controlled trials for treatment of SE (5).