Clinical outcomes and treatments effectiveness in status epilepticus resolved by antiepileptic drugs: A five‐year observational study

Abstract

Objective: To evaluate clinical outcomes and treatment effectiveness of status epilepticus finally resolved by nonbenzodiazepine antiepileptic drugs (AEDs). Methods: All consecutive SE episodes observed from September 1, 2013, to September 1, 2018, and resolved by AEDs were considered. Diagnosis and classification of SE followed the 2015 ILAE proposal. Nonconvulsive status (NCSE) diagnosis was confirmed according to the Salzburg EEG criteria. The modified Rankin Scale and deaths at 30 days from onset were used to evaluate outcomes. Results: A total of 277 status episodes (mean age 71 years; 61% female) were treated and resolved by antiepileptic drugs after 382 treatment trials. 68% of the SE resolved after AED use as first/second treatment line, while subsequent trials with AEDs gave an additional 32% resolution. A return to baseline conditions was observed in 48% of the patients, while overall mortality was 19% without significant changes across the study years. Mortality was higher in NCSE than in convulsive SE (22.5% vs 12.9%; P < .05), while mortality did not differ in SE episodes resolved by a first/second AED trial (17.2%) versus SE resolved by successive treatment trials (18.9%). The resolution rate of intravenous AEDs was 82% for valproate, 77% for lacosamide, 71% for phenytoin, and 62% for levetiracetam. No significant differences were found in head-to-head comparison, but for the valproate-levetiracetam one that was related to NCSE episodes in which valproate resulted to be effective in 86% of the trials while levetiracetam in 62% (P < .002). Significance: A high short-term mortality, stable over time, was observed in SE despite resolution of seizures, especially in SE with nonconvulsive semiology.Comparative AED efficacy showed no significant differences except for higher resolution rate for valproate versus levetiracetam in NCSE. K E Y W O R D Slacosamide, levetiracetam, mortality, outcomes, status epilepticus, valproate

Efficacy of lacosamide and phenytoin in status epilepticus: A systematic review

“…Among these, 86 articles were found to be irrelevant based on either the title, type of article, or abstract and hence removed accordingly (Figure 1). Subsequently, a full‐text review was performed for 29 articles, and finally, five articles satisfied all the inclusion criteria for our review 11–15 …”

Status epilepticus with prominent motor symptoms clusters into distinct electroclinical phenotypes

“…Before 2015, SE was considered as a continuous seizure that lasts ≥5 min or two or more discrete seizures, between which there is no complete recovery of consciousness [9]. After 2015, the operational definition proposed by the ILAE was adopted and prospectively ap- A specific "Status Epilepticus Form" was used to collect demographic and clinical information for each case, including age, gender, place of residence, site and date of SE onset, semiology of SE, etiology, type, duration, and dosage of anti-seizure medications (ASMs), anesthetic drugs and other therapies used, as previously reported [10][11][12]. The form was filled in by the first doctor who took care of the patient (in all cases, a neurologist or a neurointensivist) or by the staff of the neurophysiology unit who performed the first electroencephalogram (EEG) examination of a suspected SE case.…”

Intravenous brivaracetam in status epilepticus: A multicentric retrospective study in Italy

“…We considered a trial with BRV successful in terminating SE (effectiveness), when it was: (1) the last drug administered within 72 -h prior the clinical and/or EEG resolution of SE, without other changes in the concomitant medication, and (2) the SE didn't recur during the entire hospital observation of the patient [10,22]. Moreover, to limit biases related to the retrospective data collection, we gathered data also on a more restrictive definition of effectiveness considering the SE episodes resolved within 6 h from IV BRV.…”

“…Fast-acting benzodiazepines (BDZ) are administered as first-line treatment, leading to SE cessation in about 60 % of cases [9]. In benzodiazepine-resistant cases, IV administration of anti-seizures medications (ASMs) is required to control SE and prevent or minimize the risk of negative long-term systemic or neuronal consequences [9,10].…”