Drilling a hole to shorten the gap: an Aotearoa New Zealand therapeutic algorithm for status epilepticus in NEUROPA (Madrid, Spain).

Status epilepticus (SE) is a life-threatening neurological emergency defined by continuous seizure activity longer than 5 minutes or by clustered seizures without recovery of consciousness. When SE persists for over 30 minutes it is associated with irreversible brain damage. Conversely, most seizures are self-limited and do not require pharmacological treatment, while some seizures may not be epileptic. The risk of overtreating such cases must, therefore, be carefully balanced against the risk of under-recognising and undertreating SE. An acquired severe brain injury (e.g., traumatic or stroke) significantly increases the risk of developing seizures, SE and epilepsy. Poor prognostic signs include major brain injury, longer duration of seizures and treatment resistance. There is a gap between clinical practice guidelines (CPGs) for the management of SE and actual clinical practice. Delayed and timid (under-dose) treatments contribute to the perpetuation of SE. A multidisciplinary approach, including early treatment with adequate doses of benzodiazepines (e.g., midazolam) with second-line treatment (e.g., levetiracetam) are key in improving clinical outcomes. Located in the exact antipode of the Manawatū Gorge, Hospital Universitario Los Madroños is a medium-size centre known for its neurorehabilitation unit where we have adopted SE CPGs from Palmerston North Hospital and adapted them to local needs and resources, promoting early intervention and staff familiarity. A pragmatic, consensus-based, site-specific algorithm helps reduce treatment delays and improves clinical outcomes, providing a viable solution to bridge care gaps.