Change in Mortality of Generalized Convulsive Status Epilepticus in High-Income Countries Over Time

Neligan, Aidan; Noyce, Alastair J.; Gosavi, Tushar Divakar; Shorvon, Simon; Köhler, Sebastian; Walker, Matthew C.

doi:10.1001/jamaneurol.2019.1268

Cited by 72 publications

(74 citation statements)

References 87 publications

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“…The in-hospital mortality rate was 22.6%, which is in line with the findings of other studies on RSE and SRSE. 3,8,48 It is important to consider inherent limitations associated with a noncontrolled study design and retrospective review format. The SE cases reported here make up a heterogeneous population having varying ages, diagnoses, and causes and severity levels of SE; individual cases may therefore respond differently to treatments and have contrasting prognoses.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, hyperammonemia was present in 38 patients (35.8%), with a trend toward higher levels of ammonia in patients who received concurrent treatment with VPA and PB. 3,8,48 It is important to consider inherent limitations associated with a noncontrolled study design and retrospective review format. We did observe pronounced hyperchloremic acidosis in one patient and pancreatitis in another patient.…”

Section: F I G U R E 2 Modified Rankin Scalementioning

confidence: 99%

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Treatment of refractory and superrefractory status epilepticus with topiramate: A cohort study of 106 patients and a review of the literature

et al. 2019

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Objective: Novel treatments are needed to control treatment-resistant status epilepticus (SE). We present a summary of clinical cases where oral topiramate (TPM) was used in refractory SE (RSE) and superrefractory SE (SRSE). Methods: A review of medical records was carried out to detect TPM administration in SE patients treated in Frankfurt and Marburg between 2011 and 2016. The primary outcome question concerned SE resolution after TPM initiation. Results: In total, TPM was used in 106 of 854 patients having a mean age of 67.4 ± 18.1 years, 61 of whom were female (57.5%). The median latency from SE onset to TPM initiation was 8.5 days. Patients with SE had previously failed a median of five other antiepileptic drugs. The median initial TPM dose was 100 mg/d, which was uptitrated to a median maintenance dose of 400 mg/d. Treatment with TPM was continued for a median time of 12 days. TPM was the last drug provided to 42 of 106 (39.6%) patients, with a resultant response attributed to TPM observed in 29 of 106 (27.4%) patients. A response was attributed to TPM in 21 (31.8%) of 66 RSE cases and eight (20%) of 40 SRSE cases. Treatment-emergent adverse events were attributed to TPM usage in two patients, one each with pancreatitis and hyperchloremic acidosis, and in 38 patients (35.8%), hyperammonemia was seen. Thirty-four of these patients received a combination of TPM and valproate and/or phenobarbital.The intrahospital mortality rate was 22.6% (n = 24). Significance: The rate of SE cessation attributed to TPM treatment (27.4%) represents a relevant response given the late treatment position of TPM and the treatment latency of more than 8 days. Based on these results and in line with the findings of other case series, TPM can be considered an alternative option for treating RSE and SRSE.

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Section: Discussionmentioning

confidence: 99%

Section: F I G U R E 2 Modified Rankin Scalementioning

confidence: 99%

Treatment of refractory and superrefractory status epilepticus with topiramate: A cohort study of 106 patients and a review of the literature

et al. 2019

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“…Status epilepticus mortality is heavily influenced by the underlying etiology, but the hope is that with more accurate definitions and with staged therapy, the outcomes can change. A recent meta-analysis of the mortality of convulsive SE, however, shows that there is no evidence of better survival over time, and more carefully defined epidemiological studies of different stages and types of SE are desperately needed to better design treatment [26].…”

Section: Discussionmentioning

confidence: 99%

Incidence of the different stages of status epilepticus in Eastern Finland: A population-based study

Kantanen

Sairanen

Kälviäinen

2019

Epilepsy & Behavior

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Objective: The objective of this study was to determine the incidence in Eastern Finland of the different stages of status epilepticus (SE): 1) at the early stage of SE (a prolonged seizure lasting over 5 min);, 2) refractory SE (RSE), and 3) super-refractory SE (SRSE). Methods: Firstly, we conducted a retrospective study on the incidence and outcome of intensive care unit (ICU)treated RSE and SRSE in the adult population (≥16 years) in Kuopio University Hospital (KUH)'s special care responsibility area (840,000 inhabitants). Secondly, we conducted a prospective study using the International League Against Epilepsy (ILAE)'s new definition for SE (prolonged seizures lasting over 5 min), in adult (≥16 years) patients in the KUH municipality district (North Savo, 248,000 inhabitants). Results: The retrospective study on ICU-treated RSE and SRSE from 2010 to 2012 identified 75 patients with RSE, of whom 21% were treated as SRSE, resulting in an annual age-adjusted incidence of ICU-treated RSE of 3.0/100,000 (95% confidence interval [CI]: 2.4-3.8) and 0.6/100,000 (95% CI: 0.4-1.0) for SRSE. In the prospective study of early stage SE (seizures lasting over 5 min), we identified 151 consecutive episodes during the 9-month study period in 2015, corresponding to an annual age-adjusted incidence of 81.1/100,000 (95% CI: 75.8-87.0). In this study, 11 seizure episodes became refractory, resulting in an age-adjusted incidence of RSE of 6.0/100,000 (95% CI: 3.4-10.4), of which seven were treated in the ICU [3.8/100,000 (95% CI: 1.8-7.8)], four were treated palliatively [2.2/100,000 (95% CI: 0.82-5.7)], and two evolved to SRSE [1.1/100,000 (95% CI: 0.3-4.3)]. Conclusions:The new ILAE 2015 definition of SE resulted in a four-fold increase in incidence of SE compared to the earlier 30-min definition reported earlier in Europe. In the epidemiology of RSE, the incidence of ICU-treated RSE, palliatively treated RSE, and SRSE needs to be separated.

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“…Sürgősségi kórkép a convulsiv status epilepticus, amikor grand mal, illetve kiterjedt clonisatióval járó rohamok jelentkeznek halmozottan. Ez megfelelő kezelés nélkül életveszélyes állapot, halálozása az akut szakban 15-25% [2,6]. Így azonnali beavatkozást, összehangolt interdiszciplináris ellátást tesz szükségessé.…”

Section: öSszefoglaló Közleményunclassified

“…Így azonnali beavatkozást, összehangolt interdiszciplináris ellátást tesz szükségessé. A mortalitás (és különösen a hosszú távú mortalitás) elsősorban az etiológiától függ [2,6], de az életkor és a status epilepticus súlyossága (hossza) is döntő tényező. Ebből a status epilepticus fennállási ideje az egyetlen befolyásolható tényező, melyet döntően az határoz meg, hogy a beteg az első órában megfelelő terápiát kap-e [7].…”

Section: öSszefoglaló Közleményunclassified

Status epilepticus 2020

Janszky

Bóné

Horváth

et al. 2020

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Absztrakt: A status epilepticus a második leggyakoribb, sürgősségi kezelést igénylő neurológiai állapot. Halálozása 15–25%. A „time is brain” elve a status epilepticus kezelésére is igaz: minél korábban kezdjük a megfelelő kezelést, annál nagyobb valószínűséggel tudjuk megállítani a progressziót. Magas szintű evidenciákon alapuló kezelési protokollal a status epilepticus progressziója az esetek 75–90%-ában megelőzhető, az indukált kóma és a halálos kimenetel elkerülhető. A status epilepticus kezelése akkor a legsikeresebb, ha már a korai szakban megkezdjük a parenteralis benzodiazepinterápiát: im. midazolám (0,2 mg/tskg, max. 10 mg). Szabad véna esetén lehet vénásan is adni a benzodiazepint (10 mg diazepám iv). Ha az első benzodiazepinbolusra nem reagál a status epilepticus, állandósult (benzodiazepinrefrakter) status epilepticusról beszélünk. Ilyenkor a benzodiazepin ismétlésével párhuzamosan nem benzodiazepin típusú, gyorsan ható vénás antiepileptikumot is adni kell: iv. valproát (40 mg/kg, max. 3000 mg, 10 perc alatt) vagy levetiracetám (60 mg/kg, max. 4500 mg, 10 perc alatt) javasolt. Az 1 órán túl is tartó, sem benzodiazepinre, sem antiepileptikumra nem reagáló, refrakter status epilepticust neurointenzív osztályon, teljes narcosissal (indukált kómával) kell kezelni. Az indukált kómát gyors hatású anesztetikummal lehet elérni, elsősorban propofol–midazolám kombinációval. Orv Hetil. 2020; 161(42): 1779–1786.

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Change in Mortality of Generalized Convulsive Status Epilepticus in High-Income Countries Over Time

Cited by 72 publications

References 87 publications

Treatment of refractory and superrefractory status epilepticus with topiramate: A cohort study of 106 patients and a review of the literature

Treatment of refractory and superrefractory status epilepticus with topiramate: A cohort study of 106 patients and a review of the literature

Incidence of the different stages of status epilepticus in Eastern Finland: A population-based study

Status epilepticus 2020

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