Polytherapy as first-line in status epilepticus: should we change our practice? “Time is brain”!

Status epilepticus (SE) is one of the most common neurologic emergencies, and is associated with significant mortality ranging from 3% to 40% in various studies (1). “Time is brain” is as important in SE as in any vascular neurologic emergencies since early and prompt treatment offers better outcome. Two decades ago in a pivotal study, Lowenstein et al. demonstrated that seizures are easier to control if treatment is initiated earlier (2). Current guidelines recommend a step-wise approach using different antiepileptic drugs (AEDs) with benzodiazepines (BZDs) being the first-line treatment. To provide a more effective and rapid treatment at the earliest, there are suggestions using more than one drug as first-line treatment, especially in a pre-hospital setting outside the premise of a hospital (3).