Calorie Intake During Status Epilepticus and Outcome: A 5-Year Cohort Study

Rybitschka, Anja; Semmlack, Saskia; Kaplan, Peter W.; Marchis, Gian Marco De; Rüegg, Stephan; Marsch, Stephan; Sutter, Raoul

doi:10.1097/ccm.0000000000003828

Cited by 9 publications

(6 citation statements)

References 47 publications

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“…As in our previous studies and according to the recent guidelines for the evaluation and management of SE, SE was defined as clinical and EEG evidence of seizure activity that lasted at least 5 minutes or as a series of epileptic seizures without complete clinical recovery between. 6 Types of SE (as described in previous studies [18][19][20][21] ) were assessed from the digital EEG databases of both centers or from prehospital and emergency department reports if EEG was not informative or not performed. SE types were defined as recommended by the current guidelines of the International League Against Epilepsy (i.e., focal nonconvulsive SE without coma [with or without altered consciousness and absence SE], SE with motor symptoms [myoclonic and convulsive], and nonconvulsive SE with coma).…”

Section: Definition and Classification Of Se Types And Durationmentioning

confidence: 99%

Safety and Efficacy of Coma Induction Following First-Line Treatment in Status Epilepticus

et al. 2021

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Objective:To explore safety and efficacy of artificial coma induction to treat status epilepticus (SE) immediately after first-line antiseizure treatment instead of following the recommended approach of first using second-line drugs.Methods:Clinical and electrophysiologic data of all adult patients treated for SE from 2017 to 2018 in the Swiss academic medical care centers from Basel and Geneva were retrospectively assessed. Primary outcomes were return to premorbid neurologic function and in-hospital death. Secondary outcomes were the emergence of complications during SE, duration of SE, ICU and hospital stay.Results:Of 230 patients, 205 received treatment escalation after first-line medication. Of those, 27.3% were directly treated with artificial coma and 72.7% with second-line non-anesthetic antiseizure drugs. Of the latter, 16.6% were subsequently put on artificial coma after failure of second-line treatment. Multivariable analyses revealed increasing odds for coma induction after first-line treatment with younger age, the presence of convulsions, and with an increased SE severity as quantified by the Status Epilepticus Severity Score (STESS). While outcomes and complications did not differ compared to patients with treatment escalation according to the guidelines, coma induction after first-line treatment was associated with shorter SE duration, ICU and hospital stay.Conclusions:Early induction of artificial coma is performed in more than every fourth patient and especially in younger patients presenting with convulsions and more severe SE. Our data demonstrate that this aggressive treatment escalation was not associated with an increase in complications but with shorter duration of SE, ICU and hospital stays.Classification of Evidence:This study provides Class III evidence that early induction of artificial coma after unsuccessful first-line treatment for SE is associated with shorter duration of SE, ICU and hospital stays compared to the use of a second-line non-anesthetic antiseizure drug instead or prior to anesthetics, without an associated increase in complications.

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Section: Definition and Classification Of Se Types And Durationmentioning

confidence: 99%

Safety and Efficacy of Coma Induction Following First-Line Treatment in Status Epilepticus

et al. 2021

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“…As described earlier (14,(35)(36)(37)(38), SE duration was defined as the time between the first clinical and/or electroencephalographic evidence of seizure and seizure termination on electroencephalograph. As our monitoring unit used two different electroencephalographic strategies, such as continuous or spot electroencephalographs of greater than or equal to 30 minutes every 12 hours, SE duration represents a 12-hour approximation.…”

Section: Se Definition Cassification and Durationmentioning

confidence: 99%

Prediction of Postictal Delirium Following Status Epilepticus in the ICU: First Insights of an Observational Cohort Study

Baumann

Semmlack

Hunziker

et al. 2021

Critical Care Medicine

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OBJECTIVES: To identify early predictors of postictal delirium in adult patients after termination of status epilepticus. DESIGN: Retrospective study. SETTING: ICUs at a Swiss tertiary academic medical center. PATIENTS: Status epilepticus patients treated on the ICUs for longer than 24 hours from 2012 to 2018. INTERVENTIONS: None. METHODS: Primary outcome was postictal delirium during post-status epilepticus treatment defined as an Intensive Care Delirium Screening Checklist greater than or equal to 4. Associations with postictal delirium were secondary outcomes. A time-dependent multivariable Cox proportional hazards model was used to identify risks of postictal delirium. It included variables that differed between patients with and without delirium and established risk factors for delirium (age, sex, number of inserted catheters, illness severity [quantified by the Sequential Organ Failure Assessment and Status Epilepticus Severity Score], neurodegenerative disease, dementia, alcohol/drug consumption, infections, coma during status epilepticus, dose of benzodiazepines, anesthetics, and mechanical ventilation). MEASUREMENTS AND MAIN RESULTS: Among 224 patients, post-status epilepticus Intensive Care Delirium Screening Checklist was increased in 83% with delirium emerging in 55% with a median duration of 2 days (interquartile range 1–3 d). Among all variables, only the history of alcohol and/or drug consumption was associated with increased hazards for delirium in multivariable analyses (hazard ratio = 3.35; 95% CI, 1.53–7.33). CONCLUSIONS: Our study provides first exploratory insights into the risks of postictal delirium in adult status epilepticus patients treated in the ICU. Delirium following status epilepticus is frequent, lasting mostly 2–3 days. Our findings that with the exception of a history of alcohol and/or drug consumption, other risk factors of delirium were not found to be associated with a risk of postictal delirium may be related to the limited sample size and the exploratory nature of our study. Further investigations are needed to investigate the role of established risk factors in other status epilepticus cohorts. In the meantime, our results indicate that the risk of delirium should be especially considered in patients with a history of alcohol and/or drug consumption.

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“…This therapy should be started and monitored by a physician experienced in KD, or a nutritional expert, to avoid electrolyte or vitamin imbalance or hypoglycemia, and standardized protocols should be followed [157]. A recent study on the nutritional state in SE showed that the induction of ketogenesis might improve treatment outcomes and will surely stimulate the conduct of further research into the adoption of KD in SE [183]. The use and benefits of MgSO 4 in non-eclamptic RSE are controversially discussed within the field [26,184] and are only supported by weak evidence (level 5, grade D).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Options for Patients with Refractory Status Epilepticus in Palliative Settings or with a Limitation of Life-Sustaining Therapies: A Systematic Review

et al. 2020

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Background Refractory status epilepticus (RSE) represents a serious medical condition requiring early and targeted therapy. Given the increasing number of elderly or multimorbid patients with a limitation of life-sustaining therapy (LOT) or within a palliative care setting (PCS), guidelines-oriented therapy escalation options for RSE have to be omitted frequently. Objectives This systematic review sought to summarize the evidence for fourth-line antiseizure drugs (ASDs) and other minimally or non-invasive therapeutic options beyond guideline recommendations in patients with RSE to elaborate on possible treatment options for patients undergoing LOT or in a PCS. Methods A systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, focusing on fourth-line ASDs or other minimally or non-invasive therapeutic options was performed in February and June 2020 using the MEDLINE, EMBASE and Cochrane databases. The search terminology was constructed using the name of the specific ASD or therapy option and the term 'status epilepticus' with the use of Boolean operators, e.g. "(brivaracetam) AND (status epilepticus)". The respective Medical Subject Headings (MeSH) and Emtree terms were used, if available. ResultsThere is currently no level 1, grade A evidence for the use of ASDs in RSE. The best evidence was found for the use of lacosamide and topiramate (level 3, grade C), followed by brivaracetam, perampanel (each level 4, grade D) and stiripentol, oxcarbazepine and zonisamide (each level 5, grade D). Regarding non-medicinal options, there is little evidence for the use of the ketogenic diet (level 4, grade D) and magnesium sulfate (level 5, grade D) in RSE. The broad use of immunomodulatory or immunosuppressive treatment options in the absence of a presumed autoimmune etiology cannot be recommended; however, if an autoimmune etiology is assumed, steroid pulse, intravenous immunoglobulins and plasma exchange/plasmapheresis should be considered (level 4, grade D). Even if several studies suggested that the use of neurosteroids (level 5, grade D) is beneficial in RSE, the current data situation indicates that there is formal evidence against it. Conclusions RSE in patients undergoing LOT or in a PCS represents a challenge for modern clinicians and epileptologists. The evidence for the use of ASDs in RSE beyond that in current guidelines is low, but several effective and well-tolerated options are available that should be considered in this patient population. More so than in any other population, advance care planning, advance directives, and medical ethical aspects have to be considered carefully before and during therapy.

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Calorie Intake During Status Epilepticus and Outcome: A 5-Year Cohort Study

Cited by 9 publications

References 47 publications

Safety and Efficacy of Coma Induction Following First-Line Treatment in Status Epilepticus

Safety and Efficacy of Coma Induction Following First-Line Treatment in Status Epilepticus

Prediction of Postictal Delirium Following Status Epilepticus in the ICU: First Insights of an Observational Cohort Study

Therapeutic Options for Patients with Refractory Status Epilepticus in Palliative Settings or with a Limitation of Life-Sustaining Therapies: A Systematic Review

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