Early timing of anesthesia in status epilepticus is associated with complete recovery: A 7‐year retrospective two‐center study

Abstract

Objective: This study was undertaken to investigate the efficacy, tolerability, and outcome of different timing of anesthesia in adult patients with status epilepticus (SE). Methods:Patients with anesthesia for SE from 2015 to 2021 at two Swiss academic medical centers were categorized as anesthetized as recommended thirdline treatment, earlier (as first-or second-line treatment), and delayed (later as third-line treatment). Associations between timing of anesthesia and in-hospital outcomes were estimated by logistic regression.Results: Of 762 patients, 246 received anesthesia; 21% were anesthetized as recommended, 55% earlier, and 24% delayed. Propofol was preferably used for earlier (86% vs. 55.5% for recommended/delayed anesthesia) and midazolam for later anesthesia (17.2% vs. 15.9% for earlier anesthesia). Earlier anesthesia was statistically significantly associated with fewer infections (17% vs. 32.7%), shorter median SE duration (.5 vs. 1.5 days), and more returns to premorbid neurologic function (52.9% vs. 35.5%). Multivariable analyses revealed decreasing odds for return to premorbid function with every additional nonanesthetic antiseizure medication given prior to anesthesia (odds ratio [OR] = .71, 95% confidence interval [CI] = .53-.94) independent of confounders. Subgroup analyses revealed decreased odds for return to premorbid function with increasing delay of anesthesia independent of the Status Epilepticus Severity Score

Post‐hypoxic status epilepticus – A distinct subtype of status epilepticus with poor prognosis

“…While aggressive treatment as early as possible is imperative in non‐hypoxic SE, 4 , 39 it remains uncertain whether the treatment of SE and EEG patterns not fulfilling criteria for definitive SE in post‐hypoxic patients influence outcome. Unstandardized and moderate‐intensity treatment, which is often used in clinical practice, has not been shown to improve outcome.…”

Sustained effort network for treatment of status epilepticus/European academy of neurology registry on adult refractory status epilepticus (SENSE-II/AROUSE)

“…Although CIVADs are recommended as third-line treatment and are safe to use as second-line [ 25 ], there is currently limited evidence to guide this third-line and later treatments on convulsive and other types of SE.…”

Letter to the editor regarding “early timing of anesthesia in status epilepticus is associated with complete recovery: A 7‐year retrospective two‐center study”

“…We read with great interest the recently published paper "Early timing of anesthesia in status epilepticus is associated with complete recovery: A 7-year retrospective two-center study". 1 The authors, focusing on a relevant question, analyzed 246 status epilepticus (SE) episodes receiving intubation (of 762 patients overall with SE treated in two hospitals), concluding that early anesthesia is associated with better outcome, shorter SE duration, and fewer infections.…”