Author response: Therapeutic coma for status epilepticus: Differing practices in a prospective multicenter study

We thank Dr. Sethi for the interest in our article.¹ We agree the management of status epilepticus (SE) should be progressive using successive lines of antiseizure drugs (ASD), as recommended by the European and American guidelines.^2,3 Therapeutic coma (TC) is sometimes needed; however, since the benefits of TC are not yet clear,⁴ we strongly believe that a “shotgun” approach should be avoided because it might harm the patient.⁵ We demonstrated that a more conservative approach was not associated with increased mortality, but avoiding TC correlated with a shorter length of hospital stay and a trend towards a better functional outcome.¹ The best approach, as Dr. Sethi suggests, is probably to strictly adhere to the proposed treatment algorithms,³ using correctly dosed benzodiazepines followed by one nonsedating ASD. Eventually, after a careful case-by-case risk–benefit assessment, a decision to start TC may be taken. TC is often designated for patients with refractory generalized convulsive SE (awaiting further studies); nevertheless, in patients with focal SE and partly preserved consciousness, subsequent trials of nonsedating ASD before considering TC appears more appropriate.⁴