Management of status epilepticus in Malaysia: A national survey of current practice and treatment gap

Lim KS 1 , Khoo CS 2 , Fong SL 3 , Tan HJ 2 , Fong CY 4 , Mohamed AR 5 Show all authors , Rashid AA 6 , Law WC 7 , Shaikh MF 8 , Khalid RA 9 , Yen-Leong Tan R 10 , Ahmad SB 11 , Chinnasami S 12 , Wong SW 13 , Raymond AA 14 , Epilepsy Council of Malaysia 15

Affiliations 

  • 1 Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia. Electronic address: kslimum@gmail.com
  • 2 Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
  • 3 Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
  • 4 Division of Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Malaysia
  • 5 Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
  • 6 KPJ Damansara Specialist Hospital, Selangor, Malaysia
  • 7 Division of Neurology, Department of Medicine, Sarawak General Hospital, Malaysia
  • 8 Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia; School of Dentistry and Medical Sciences, Charles Sturt University, Orange, New South Wales, Australia
  • 9 Department of Medicine, Assunta Hospital, Selangor, Malaysia
  • 10 Department of Medicine, Sunway Medical Centre, Selangor, Malaysia
  • 11 Department of Medicine, Subang Jaya Medical Centre, Selangor, Malaysia
  • 12 Neurology Department, Hospital Kuala Lumpur, Malaysia
  • 13 Neurology Unit, Department of Paediatrics, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
  • 14 Neurology Unit, Department of Medicine, Faculty of Medicine, MARA University of Technology, Malaysia
  • 15 Epilepsy Council Malaysia, Malaysian Society of Neurosciences, Malaysia
J Clin Neurosci, 2023 Aug;114:25-31.
PMID: 37279626 DOI: 10.1016/j.jocn.2023.05.006

Abstract

INTRODUCTION: Early and effective treatment is fundamental in status epilepticus (SE) management. At the initiative of the Epilepsy Council of Malaysia, this study aimed to determine the treatment gap in SE across different healthcare settings in Malaysia.

METHODS: A web-based survey was sent to clinicians involved in the management of SE, across all states and at all levels of healthcare services.

RESULTS: A total of 158 responses were received from 104 health facilities, including 23 tertiary government hospitals (95.8% of all government tertiary hospitals in Malaysia), 4 (80.0%) universities, 14 (6.7%) private, 15 (11.5%) district hospitals and 21 clinics. Intravenous (IV) diazepam was available in 14 (93.3%) district and 33 (80.5%) tertiary hospitals for prehospital management. Non-IV benzodiazepine (rectal diazepam and intramuscular midazolam) was not widely available in prehospital services (75.8% and 51.5%). Intramuscular midazolam was underutilised (60.0% in district and 65.9% in tertiary hospitals). IV sodium valproate and levetiracetam were only available in 66.7% and 53.3% of the district hospitals, respectively. Electroencephalogram (EEG) services were available in only 26.7% of the district hospitals. Non-pharmacological therapies such as ketogenic diet, electroconvulsive therapy, and therapeutic hypothermia were not available in most district and tertiary hospitals for refractory and super-refractory SE.

CONCLUSIONS: We identified several gaps in the current practice of SE management, including limited availability and underutilization of non-IV midazolam in prehospital services, underutilization of non-IV midazolam and other second-line ASMs, and lack of EEG monitoring in district hospitals and limited treatment options for refractory and super-refractory SE in tertiary hospitals.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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