Abstract
BACKGROUND AND OBJECTIVES: Status epilepticus (SE) is a neurologic emergency with disproportionate mortality and morbidity in low- and middle-income countries. Existing SE guidelines are largely based on high-income country contexts, limiting applicability in settings with diagnostic, therapeutic, and infrastructural constraints. We aimed to examine expert clinician perspectives on SE management across recourse-limited settings to identify common barriers and context-specific strategies. METHODS: This study used a convergent parallel mixed methods approach, interconnecting quantitative and qualitative data collected from an online survey. Experts in SE management were purposively sampled to balance clinical expertise across 3 physician disciplines (neurology, emergency medicine, and critical care) and geographic locations. Invitations to participate were sent to 48 experts from 22 different countries. Qualitative data using thematic analysis and descriptive statistics for quantitative analysis was used. RESULTS: We received responses from 28 clinical experts, spanning 15 countries across 4 continents. Over 96% (27/28) agreed on the importance of guidelines or relevant subsections applicable to resource-limited settings. Experts highlighted inadequate SE education at multiple levels, but less than half (12/28) reported discussing SE management during routine clinic visits. A common theme was a lack of access to anti-seizure medications (ASMs), with 86% (24/28) agreeing that oral ASMs should be included in SE guidelines, although there was no consensus on what these should be. Only 39% (11/28) of experts had consistent access to electroencephalography (EEG), and there was little agreement about the duration and frequency of serial intermittent EEGs in the absence of continuous EEG. Nearly all experts (27/28) agreed that multicenter international efforts are essential to understand current practices and to improve patient outcomes. Other proposed solutions included implementing locally adapted practices to improve care, such as remote tele-monitoring and improving SE education and training. DISCUSSION: This study provides the most geographically diverse expert insight to date on SE care in recourse-limited settings, underscoring systemic barriers that transcend clinical decision-making. Inclusive, context-sensitive frameworks and implementation strategies are urgently needed. Our findings provide expert-informed priorities to guide future policy, research, and clinical practice for equitable SE care.