Costs, length of stay, and mortality of super‐refractory status epilepticus: A population‐based study from Germany

Strzelczyk, Adam; Ansorge, Sonja; Hapfelmeier, Jana; Bonthapally, Vijayveer; Erder, M. Haim; Rosenow, Felix

doi:10.1111/epi.13837

Cited by 158 publications

(180 citation statements)

References 39 publications

Supporting

Mentioning

141

Contrasting

Unclassified

Order By: Relevance

“…The 3-month mortality rates for non-RSE, RSE, and SRSE were 18.2, 20.0, and 45.5% respectively. The mortality rates of RSE and SRSE in our study are a little higher than results from one German study [14] but were consistent with the results of one study from West China [15]. Forty-two patients were lost in the follow-up for evaluating DRE development (17 cases lost until September 2012, another 25 cases lost until November 2017), 1 patient was excluded due to lack of treatment compliance.…”

Section: Study Population and Outcomessupporting

confidence: 89%

Early Predictors of Drug-Resistant Epilepsy Development after Convulsive Status Epilepticus

et al. 2018

View full text Add to dashboard Cite

Background: Drug-resistant epilepsy (DRE) is a common and serious consequence of convulsive status epilepticus (CSE). Little is known on the early prediction of DRE development after CSE. Our aim was to identify independent DRE predictors in patients with CSE. Methods: One hundred and forty consecutive patients identified with CSE in a tertiary academic hospital between March 2008 and January 2015 were reviewed. Demographics, clinical features, serum albumin neuroimaging, and electroencephalogram characteristics were collected and analyzed. Independent predictors of DRE were identified using multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to quantify the predictive validity of all the risk factors. Results: After a median 62-month observation period, 91 patients were enrolled into this study. Thirty-seven (40.7%) patients did not have DRE, 22 (24.2%) developed DRE, and 32 (35.2%) were dead. History of epilepsy (OR 9.17, 95% CI 1.77–49.22, p = 0.010), status epilepticus duration ≥24 h (OR 4.82, 95% CI 1.04–22.37, p = 0.044), and cortical or hippocampal abnormalities on neuroimaging (OR 9.49, 95% CI 1.90–47.50, p = 0.006) were independent predictors of DRE after CSE. A combination of these 3 variables yielded an area under the ROC curve of 0.77 (0.65–0.89). Conclusions: History of epilepsy, longer SE duration, and cortical or hippocampal abnormalities on neuroimaging are early predictors for the development of DRE after CSE. Further studies are needed to assess whether a more aggressive treatment will reduce the likelihood of DRE development in these high-risk patients.

show abstract

Section: Study Population and Outcomessupporting

confidence: 89%

Early Predictors of Drug-Resistant Epilepsy Development after Convulsive Status Epilepticus

et al. 2018

View full text Add to dashboard Cite

show abstract

“…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%

“…[1][2][3][4][5] Refractory SE (RSE) and superrefractory SE (SRSE) are characterized by the failure of first-, second-, and third-line therapy and, in the latter case, anesthetic therapy. It requires instant medical intervention and is accompanied by prolonged hospital stays and increased health care costs.…”

Section: Introductionmentioning

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…11,13,14 The reported incidence of seizures in cSDH varies in between 2% and 42%, and some predictors, such as alcoholism, male sex, low Glasgow Coma Scale (GCS) at admission, previous stroke, and hematoma density, were identified in a smaller number of patients. 24,25 Indeed, there are further questions remaining as to with which prognosis and perspective we should be alerted and treat the patients with cSDH-associated ASz. 9,[14][15][16][17][18][19][20][21][22][23] Furthermore, the significance of status epilepticus (SE) in cSDH, which is associated with even higher morbidity and mortality, is not well studied.…”

Section: Introductionmentioning

confidence: 99%

Seizure and status epilepticus in chronic subdural hematoma

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: Acute symptomatic seizure (ASz) and status epilepticus (SE) are serious conditions associated with poor quality of life, with unfavorable psychosocial and functional outcome. Chronic subdural hematoma (cSDH) is a common neurosurgical disease related to those complications; therefore, we aimed to evaluate incidence, predictors of ASz/SE, and outcome in this cohort. Methods:We retrospectively analyzed patient diagnosed cSDH between 2010 and 2017. Beside their incidence of ASz/SE, patient characteristics, symptoms at admission, comorbidities, and all previously published relevant parameters were assessed.Recurrence rate and functional outcome were analyzed at hospital discharge and 90-day follow-up.Results: A total of 375 patients were included; incidence of ASz was 15.2% and of SE, 1.9%. In the univariate analysis, drainage insertion (P = 0.004; OR = 0.3) was a significant negative predictor for ASz/SE and multivariate analysis, including all significant parameters, designated GCS ≤13 at admission (P = 0.09; OR = 1.9), remote stroke (P = 0.009; OR = 2.9), and recurrence rate within 14 days (P = 0.001; OR = 3.3;with an incidence of 13%) as independent predictors for ASz/SE. Overall, patients with ASz/SE had significantly unfavorable outcome at discharge (54.7%; P < 0.001) and follow-up (39.5%; P < 0.001) with only slight improvement. Late seizures occurred in 3.8% within follow-up period. Any patient with SE had an unfavorable outcome at discharge without any improvement at follow-up having a mortality rate of 14.2%.Conclusion: Independent predictors for ASz/SE are GCS ≤13 at admission, remote stroke, and recurrent hematoma in patients with cSDH, which is associated with worse functional outcome, particularly those with SE. Due to the higher rate of seizures than recurrence rate, a routine pre-and postoperative EEG besides CT is recommended. K E Y W O R D Schronic subdural hematoma, EEG, functional outcome, predictors, seizures, status epilepticus | 195 WON et al.

show abstract

Costs, length of stay, and mortality of super‐refractory status epilepticus: A population‐based study from Germany

Cited by 158 publications

References 39 publications

Early Predictors of Drug-Resistant Epilepsy Development after Convulsive Status Epilepticus

Early Predictors of Drug-Resistant Epilepsy Development after Convulsive Status Epilepticus

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

Seizure and status epilepticus in chronic subdural hematoma

Contact Info

Product

Resources

About